Feasibility of wide detector CT perfusion imaging performed during routine staging and restaging of pancreatic ductal adenocarcinoma

O’Malley, Ryan B.; Soloff, Erik V.; Coveler, Andrew L.; Cox, Danielle; Desai, Nitin; Busey, Janet M.; Valentin, G.; Wang, Carolyn L.

doi:10.1007/s00261-020-02786-y

Cited by 7 publications

(10 citation statements)

References 20 publications

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“…In 9 studies, permeability surface product (PS) was measured for both PDAC and non-tumorous pancreatic parenchyma in a total of 349 patients. In all these studies, the mean permeability was lower in pancreatic tumor tissue [22,23,25,26,30,32,33,35,36]. In two studies, this difference was statistically significant [22,33].…”

Section: Diagnosismentioning

confidence: 87%

“…In 15 out of 21 studies, BF was measured in both PDAC and non-tumorous pancreatic parenchyma, including a total of 519 patients. In all these studies, mean blood flow was significantly lower in tumor tissue compared to pancreatic parenchyma outside the tumor or in healthy pancreatic tissue in a control group [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Mean BF ranged from 17 to 60 mL/100 g/min for PDAC and 71-164 mL/100 g/min for pancreatic parenchyma.…”

Section: Diagnosismentioning

confidence: 93%

“…As PDAC is known to be heterogeneous, an ROI in a single slice could introduce measurement bias. This is also highlighted in two studies reporting an increase in perfusion values towards the rim of the tumor [25,36]. A 3D volume of interest would be a more reliable measurement and allows a better understanding of the whole tumor.…”

Section: Kinetic Models/scan Parametersmentioning

confidence: 94%

“…A novel scanning method of an interleaved CTP protocol, where the perfusion acquisition was interleaved with a diagnostic multiphase contrast CECT was introduced in 2013 [43]. This method requires only one contrast bolus, instead of two separate boluses for the perfusion scan and diagnostic scan, allowing for a 'one-stop-shop' approach [25,43,44]. Two studies demonstrated that simultaneous acquisition of perfusion and high-quality diagnostic images with a single contrast bolus was feasible without difference in quality compared to conventional CECT [25,44].…”

Section: Scanning Protocolsmentioning

confidence: 99%

“…There are several developments which could help to bring CTP into clinical practice. Advanced interleaved techniques make it possible to perform CTP during routine multiphase contrast-enhanced pancreatic CT using a single-contrast injection [25,44]. In such a 'one-stop-shop' procedure, perfusion information is acquired without extra time and cost for the patient and can be applied in oncologic imaging adding functional information.…”

Section: Future Perspectivesmentioning

confidence: 99%

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Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review

et al. 2021

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Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death with a 5-year survival rate of 10%. Quantitative CT perfusion (CTP) can provide additional diagnostic information compared to the limited accuracy of the current standard, contrast-enhanced CT (CECT). This systematic review evaluates CTP for diagnosis, grading, and treatment assessment of PDAC. The secondary goal is to provide an overview of scan protocols and perfusion models used for CTP in PDAC. The search strategy combined synonyms for ‘CTP’ and ‘PDAC.’ Pubmed, Embase, and Web of Science were systematically searched from January 2000 to December 2020 for studies using CTP to evaluate PDAC. The risk of bias was assessed using QUADAS-2. 607 abstracts were screened, of which 29 were selected for full-text eligibility. 21 studies were included in the final analysis with a total of 760 patients. All studies comparing PDAC with non-tumorous parenchyma found significant CTP-based differences in blood flow (BF) and blood volume (BV). Two studies found significant differences between pathological grades. Two other studies showed that BF could predict neoadjuvant treatment response. A wide variety in kinetic models and acquisition protocol was found among included studies. Quantitative CTP shows a potential benefit in PDAC diagnosis and can serve as a tool for pathological grading and treatment assessment; however, clinical evidence is still limited. To improve clinical use, standardized acquisition and reconstruction parameters are necessary for interchangeability of the perfusion parameters. Graphic abstract

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Section: Diagnosismentioning

confidence: 87%

Section: Diagnosismentioning

confidence: 93%

Section: Kinetic Models/scan Parametersmentioning

confidence: 94%

Section: Scanning Protocolsmentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

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Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review

et al. 2021

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CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging

et al. 2022

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Fractal analysis improves tumour size measurement on computed tomography in pancreatic ductal adenocarcinoma: comparison with gross pathology and multi-parametric MRI

et al. 2022

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Objectives Tumour size measurement is pivotal for staging and stratifying patients with pancreatic ductal adenocarcinoma (PDA). However, computed tomography (CT) frequently underestimates tumour size due to insufficient depiction of the tumour rim. CT-derived fractal dimension (FD) maps might help to visualise perfusion chaos, thus allowing more realistic size measurement. Methods In 46 patients with histology-proven PDA, we compared tumour size measurements in routine multiphasic CT scans, CT-derived FD maps, multi-parametric magnetic resonance imaging (mpMRI), and, where available, gross pathology of resected specimens. Gross pathology was available as reference for diameter measurement in a discovery cohort of 10 patients. The remaining 36 patients constituted a separate validation cohort with mpMRI as reference for diameter and volume. Results Median RECIST diameter of all included tumours was 40 mm (range: 18–82 mm). In the discovery cohort, we found significant (p = 0.03) underestimation of tumour diameter on CT compared with gross pathology (Δdiameter3D = −5.7 mm), while realistic diameter measurements were obtained from FD maps (Δdiameter3D = 0.6 mm) and mpMRI (Δdiameter3D = −0.9 mm), with excellent correlation between the two (R2 = 0.88). In the validation cohort, CT also systematically underestimated tumour size in comparison to mpMRI (Δdiameter3D = −10.6 mm, Δvolume = −10.2 mL), especially in larger tumours. In contrast, FD map measurements agreed excellently with mpMRI (Δdiameter3D = +1.5 mm, Δvolume = −0.6 mL). Quantitative perfusion chaos was significantly (p = 0.001) higher in the tumour rim (FDrim = 4.43) compared to the core (FDcore = 4.37) and remote pancreas (FDpancreas = 4.28). Conclusions In PDA, fractal analysis visualises perfusion chaos in the tumour rim and improves size measurement on CT in comparison to gross pathology and mpMRI, thus compensating for size underestimation from routine CT. Key Points • CT-based measurement of tumour size in pancreatic adenocarcinoma systematically underestimates both tumour diameter (Δdiameter = −10.6 mm) and volume (Δvolume = −10.2 mL), especially in larger tumours. • Fractal analysis provides maps of the fractal dimension (FD), which enable a more reliable and size-independent measurement using gross pathology or multi-parametric MRI as reference standards. • FD quantifies perfusion chaos—the underlying pathophysiological principle—and can separate the more chaotic tumour rim from the tumour core and adjacent non-tumourous pancreas tissue.

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Feasibility of wide detector CT perfusion imaging performed during routine staging and restaging of pancreatic ductal adenocarcinoma

Cited by 7 publications

References 20 publications

Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review

Quantitative CT perfusion imaging in patients with pancreatic cancer: a systematic review

CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging

Fractal analysis improves tumour size measurement on computed tomography in pancreatic ductal adenocarcinoma: comparison with gross pathology and multi-parametric MRI

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