Comparison of Perfusion CT and Conventional Thin-slice Multiphase CT in the Diagnosis of Pancreatic Adenocarcinoma.

Abstract

Rationale and objectives: Perfusion CT parameters are reported to correlate with pancreatic adenocarcinoma's histopathological response to radiochemotherapy, yet research on morphological diagnosis of perfusion CT for the diagnosis of pancreatic adenocarcinoma is lacking. This study compares mean temporal (MT) post-processed perfusion CT with conventional thin-slice multiphase CT in visualizing tumors, small pancreatic arteries, and assessing tumor resectability.

Materials and methods: 60 patients (mean age 61.3 ± 8.8, 36 males) underwent perfusion and conventional CT sequentially from December 2021 to April 2024 were retrospectively included. MT images were calculated from perfusion CT and compared with conventional images for tumor depiction (qualitative 5-point scale, quantitative analysis), small pancreatic arteries display (qualitative 4-point scale) and concordance in tumor resectability. Radiation doses were also evaluated.

Results: MT images showed superior tumor display scores (5 (4,5) vs. 4 (4,5)), better tumor contrast (99.54 (81.88, 117.29) vs. 51.90 ± 18.85), higher signal-to-noise ratio (4.46 ± 1.75 vs. 3.10 ± 0.98), and contrast-to-noise ratio (5.13 (3.84, 6.77) vs. 3.03 ± 1.24), with all p values < 0.001. Qualitative scores for small pancreatic arteries were higher in MT images, with most p values <0.05 (range from <0.001 to 0.018). Both radiologists showed good resectability consistency, with κ values of 0.740 and 0.785, respectively. Effective radiation doses were 11.86 (9.45, 15.57) mSv for perfusion CT and 12.47 ± 4.01 mSv for conventional CT (p=0.958).

Conclusion: Perfusion CT employing MT post-processing outperforms conventional CT in depicting tumors and small pancreatic arteries, with consistent resectability results between the two examinations.