Rationale and Objectives
To investigate 64 computed tomography (CT) perfusion imaging features of patients with pancreatic cancer and mass-forming chronic pancreatitis.
Materials and Methods
Between January 2003 and April 2010, 234 patients with pancreatic mass underwent 64-CT perfusion imaging. Among them, the histopathological results of 64 patients were proven to be pancreatic adenocarcinoma and 15 patients were proven to be mass-forming chronic pancreatitis. Additionally, CT perfusion imaging was performed in 33 healthy volunteers served as controls. The slice data were processed using CT perfusion software. Perfusion parameters including time density curve, blood flow, blood volume, permeability, peak enhancement, and time to peak were recorded.
Results
Blood flow was 77% lower in patients with pancreatic adenocarcinoma than in controls, 48% lower in patients with mass-forming chronic pancreatitis than in controls, and 56% lower in patients with pancreatic adenocarcinoma than with mass-forming chronic pancreatitis ( P < .016). Blood volume was 65% lower in pancreatic adenocarcinoma than in controls, 27% lower in mass-forming chronic pancreatitis than in controls, and 53% lower in cancer than mass-forming chronic pancreatitis ( P < .016). Permeability was 559% higher in pancreatic adenocarcinoma than in controls, 821% higher in mass-forming chronic pancreatitis than in controls, and 28% lower in cancer than mass-forming chronic pancreatitis ( P < .016). Peak enhancement was 27% lower and time to peak 23% longer in pancreatic adenocarcinoma than mass-forming chronic pancreatitis ( P < .016). Time-density curve showed the peak of mass-forming chronic pancreatitis is earlier and higher than that of pancreatic adenocarcinoma, and the peak of mass-forming chronic pancreatitis is later and lower than that of controls.
Conclusion
CT perfusion imaging can provide additional quantitative hemodynamic information of pancreatic adenocarcinoma and mass-forming chronic pancreatitis.
Pancreatic cancer, the fourth highest cause of cancer-related death, remains an incurable and rapidly lethal disease, with a 5-year survival rate of less than 3% . Radical surgery is only possible in 20% of patients . The majority of the patients are already in the later stage of disease at the time of diagnosis and half of them do not survive more than 1 year . For those who undergo surgical bypass with unresectable cancer or occult metastasis, surgical mortality rate is 16% with no survival advantage . This poor survival rate and bad prognosis are associated with the diagnosis in advanced stage, which precludes the only potential curative treatment: surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and so new insights into the early diagnosis of this lethal disease are urgently needed . Discrimination between pancreatic adenocarcinoma and mass-forming chronic pancreatitis in the early stage is usually a clinical issue. Data are limited on identification of a role for the perfusion imaging in the differential diagnosis of pancreatic cancer and mass-forming chronic pancreatitis which may hold promise for new diagnostic approaches.
Perfusion computed tomography (CT) is a topic of current interest. CT perfusion imaging allows functional information to be obtained by reflecting the hemodynamic changes of tissues in addition to anatomical detail and has enabled measurement of tissue blood perfusion and capillary permeability of the brain, kidney, heart, liver, spleen, and pancreas . Miles for the first time measured the perfusion parameters of normal pancreas in 1995 . Although small sample exploratory studies about CT perfusion imaging in normal tissue of pancreas, pancreatic cancer, and pancreatic endocrine tumors were conducted after that, its role in discriminating pancreatic cancer from mass-forming chronic pancreatitis has not been well defined . CT perfusion imaging allows noninvasive absolute quantification of pancreatic perfusion and may intensify the precision of the differential diagnosis of pancreatic cancer and mass-forming chronic pancreatitis .
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Materials and methods
Research Subjects
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CT Perfusion Procedure
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Data Processing
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Statistical Analysis
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Results
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Perfusion CT Parameters of Pancreatic Adenocarcinoma
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Table 1
The Comparisons of Perfusion Parameters in Patients with Pancreatic Adenocarcinoma, Patients with Mass-forming Chronic Pancreatitis and Normal Subjects (Mean ± Standard Deviation)
Pancreatic Adenocarcinoma
( n = 64) Mass-forming Chronic Pancreatitis
( n = 15) Controls
( n = 33) Blood flow (mL/min/mL) 0.365 ± 0.204 ∗ 0.820 ± 0.345 ∗† 1.567 ± 0.379 Blood volume (mL/mL) 0.089 ± 0.042 ∗ 0.191 ± 0.088 ∗† 0.258 ± 0.041 Permeability (mL/mL/min) 0.956 ± 0.556 ∗ 1.336 ± 0.582 ∗† 0.145 ± 0.088 Peak enhancement (HU) 30.858 ± 15.860 ∗ 42.166 ± 23.109 ∗† 57.000 ± 13.382 Time to peak (seconds) 47.047 ± 6.124 ∗ 36.133 ± 7.726 ∗† 24.858 ± 2.881
P < .016 versus normal controls () or versus pancreatic cancer (†).
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Perfusion CT Parameters of Mass-forming Chronic Pancreatitis
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Comparison of Perfusion Parameters between Pancreatic Adenocarcinoma and Mass-forming Chronic Pancreatitis
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Discussion
Pancreatic Perfusion CT Imaging
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Diagnostic Imaging of Pancreatic Carcinoma and Mass-forming Chronic Pancreatitis
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Perfusion CT Characteristics of Pancreatic Adenocarcinoma and Mass-forming Chronic Pancreatitis
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Acknowledgments
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