Perfusion CT can predict tumoral grading of pancreatic adenocarcinoma

D’Onofrio, Mirko; Gallotti, Anna; Mantovani, William; Crosara, Stefano; Manfrin, Erminia; Falconi, Massimo; Ventriglia, Anna; Zamboni, Giulia; Manfredi, Riccardo; Mucelli, Roberto Pozzi

doi:10.1016/j.ejrad.2012.09.023

Cited by 47 publications

(52 citation statements)

References 19 publications

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“…Currently, perfusion CT of the pancreas is not widely used, but multiple recent studies have illustrated its potential advantages to conventional CT for select indications including lesion detection, noninvasive differentiation and grading of tumor types, and early prediction of necrosis in severe acute pancreatitis [21]. In regard to pancreatic tumors, perfusion CT has been shown to reliably differentiate between high-and lowgrade pancreatic adenocarcinoma using PEI and BV parameters, with 60 % sensitivity and 100 % specificity for identifying high-grade lesions [22]. This could identify patients at high risk of early death following treatment, select patients for confirmatory preoperative fine needle biopsy, and help tailor treatment strategies [22].…”

Section: Perfusion Ct Of the Pancreasmentioning

confidence: 98%

“…In regard to pancreatic tumors, perfusion CT has been shown to reliably differentiate between high-and lowgrade pancreatic adenocarcinoma using PEI and BV parameters, with 60 % sensitivity and 100 % specificity for identifying high-grade lesions [22]. This could identify patients at high risk of early death following treatment, select patients for confirmatory preoperative fine needle biopsy, and help tailor treatment strategies [22]. Similarly, pancreatic neuroendocrine tumors have been shown to have a strong correlation between blood flow and tumor grade which could help in therapeutic decision making, such as favoring follow-up rather than an aggressive approach in select patients whose tumors show favorable perfusion parameters [23].…”

Section: Perfusion Ct Of the Pancreasmentioning

confidence: 99%

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An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls

Tamm

Wagner‐Bartak

et al. 2015

Curr Radiol Rep

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The progressive advancement in computed tomography (CT) technology has enabled improved diagnosis and management of pancreatic tumors. Some of these improvements are seen in multidetector CT, dual-energy CT, perfusion CT, and post-processing techniques. Despite the technological improvement, prognosis for tumors such as pancreatic adenocarcinomas remains dismal. This review article will discuss some of the tips, tricks, and pitfalls for optimal utilization of these imaging techniques to characterize, diagnosis, and manage some of the more common pancreatic tumors such as adenocarcinomas, cystic tumors, and neuroendocrine tumors.

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Section: Perfusion Ct Of the Pancreasmentioning

confidence: 98%

Section: Perfusion Ct Of the Pancreasmentioning

confidence: 99%

An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls

Tamm

Wagner‐Bartak

et al. 2015

Curr Radiol Rep

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“…Perfusion CT can be applied to the study of the pancreas, and with this imaging technique, many authors have reported that the perfusion of pancreatic carcinoma is signifi cantly lower, compared to healthy pancreatic parenchyma [ 73 , 74 ]; as a consequence, it has been reported that perfusion CT may be useful to better delineate pancreatic carcinomas not visible at conventional contrast-enhanced CT [ 65 ]. Moreover, this functional imaging may add useful information on tumor aggressiveness, affecting treatment strategy and patient management: it has been reported that considering both Peak Enhanced Index (PEI) and Blood Volume (BV) perfusional parameters with the related cutoff values (17.8 HU and 14.8 ml/100 g, respectively), it is possible to characterize high-grade adenocarcinomas with 60 % sensitivity, 100 % specifi city, a positive predictive value of 100 %, a negative predictive value of 60 %, and 75 % accuracy [ 75 ].…”

Section: Computed Tomographymentioning

confidence: 99%

Ductal Adenocarcinoma

D’Onofrio¹,

Capelli²,

Robertis³

et al. 2014

Imaging and Pathology of Pancreatic Neoplasms

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PathologyDuctal adenocarcinoma is a malignant epithelial neoplasm with glandular (ductal) differentiation, without a predominant component of any other types of carcinoma [ 7 ].Sixty to seventy percent of ductal adenocarcinomas is located in the pancreatic head, 30 % in the body and tail, and 5 % involve the whole organ. Multifocal disease has been reported as well as synchronous or metachronous carcinomas.Carcinomas of the pancreatic head tend to cause symptoms such as painless jaundice, acute pancreatitis, and epigastric pain that radiates to the back.Carcinomas of the body-tail of the pancreas often present with unexplained weight loss, back pain, or distant metastases.Sudden onset of diabetes mellitus may be the fi rst sign of pancreatic cancer. 2Carcinomas of the pancreatic head are usually diagnosed earlier and are more often resectable than carcinomas that involve the body-tail.Surgically resected carcinomas of the pancreatic head are generally signifi cantly smaller than the tumors of the body and tail (2-3 cm versus 5-7 cm, respectively). MacroscopyOn the cut surface, the tumor usually appears as a solid fi rm mass with infi ltrative, indefi nable margins, whitish color, and hard consistency.The tumor is often surrounded by a phlogistic fi brous "cuff," derived from a focal peritumoral pancreatitis, making it sometimes hard to identify the actual dimensions of the tumor, both at imaging and macroscopically.Extensive areas of hemorrhage and necrosis with cystic cavitation are uncommon, but microscopic foci are not so uncommon.Carcinomas of the pancreatic head, with the exception of those arising in the uncinate process, almost always infi ltrate both the common bile duct and Wirsung's duct, leading to a variable degree of stenosis and upstream dilation (radiological "double-duct sign"). This causes jaundice and upstream obstructive pancreatitis, which could lead to chronic pancreatitis, characterized by the presence of fi brotic or fi bro-adipous components, associated with a variable degree of acinar cells atrophy, with duct dilatation and retention cysts formation.The involvement of duodenum and/or Vater's ampulla, frequently found in the carcinomas of the pancreatic head, causes retraction of the intestinal wall, and eventually mucosal ulceration.Invasion and thrombosis of large peripancreatic vessels, such as the splenic vein, are frequently observed in bodytail carcinomas.The pathological evaluation of the retroperitoneal resection margin provides the most important information about local recurrence and patient survival. This margin is defi ned as the peripancreatic adipose tissue behind the head of the pancreas, which is located ventral and lateral, in respect to the superior mesenteric artery [ 8 -11 ].When the tumor involves the celiac trunk or the superior mesenteric artery, it is considered unresectable; so, this involvement is rarely present in surgical pathology specimens. A focal and partial, noncircumferential, adhesion of the posterior pancreatic surface to the mesenteric vein may justify ...

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“…It was possible to show that functional parameters of VPCT can be used to differentiate between high-grade and low-grade tumors on the basis of the blood volume and the maximum enhancement [23]. Therefore, high-grade tumors generally show low blood volume and low maximum enhancement [23]. Adenocarcinomas of the pancreas usually show reduced permeability (K trans ).…”

Section: Adenocarcinomamentioning

confidence: 99%

The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas

Grözinger¹,

Grözinger²,

Horger³

2014

Fortschr Röntgenstr

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The review discusses the potential role of volume perfusion CT (VPCT) in the diagnosis and follow-up of different pathologies of the pancreas. VPCT enables a differentiation of different pancreatic tumors like adenocarcinoma or neuroendocrine tumors based on functional parameters like blood flow, blood volume and permeability. Furthermore, the article discusses the potential indications for VPCT imaging of inflammatory diseases of the pancreas such as acute or chronic pancreatitis and autoimmune pancreatitis. Key Points: ??VPCT may help to diagnose even small pancreatic tumors based on functional parameters ??Functional perfusion parameters can help to characterize pancreatic neoplasms ??In acute pancreatitis VPCT can evaluate the perfusion status of the organ Citation Format: ??Gr?zinger G., Gr?zinger A., Horger M. The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas. Fortschr R?ntgenstr 2014; 186: 1082???1093

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Perfusion CT can predict tumoral grading of pancreatic adenocarcinoma

Cited by 47 publications

References 19 publications

An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls

An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls

Ductal Adenocarcinoma

The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas

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