Perfusion CT – Can it resolve the pancreatic carcinoma versus mass forming chronic pancreatitis conundrum?

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2016-11, Vol.16 (6), p.979-987
• Main Authors: Yadav, Ajay Kumar, Sharma, Raju, Kandasamy, Devasenathipathy, Pradhan, Rajesh Kumar, Garg, Pramod Kumar, Bhalla, Ashu Seith, Gamanagatti, Shivanand, Srivastava, Deep N, Sahni, Peush, Upadhyay, Ashish Datt
• Format: Article
• Language: English
• Subjects: Abdomen; Accuracy; Adenocarcinoma; Adult; Aged; Blood; Blood Volume; Chronic pancreatitis; Cysts; Diagnosis, Differential; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; Image Processing, Computer-Assisted; Male; Medical imaging; Medical prognosis; Middle Aged; Pancreas; Pancreas - blood supply; Pancreatic Neoplasms; Pancreatic Neoplasms - diagnostic imaging; Pancreatitis, Chronic - diagnostic imaging; Perfusion CT; Perfusion Imaging - methods; Regional Blood Flow; Sensitivity and Specificity; Standard deviation; Surgery; Tomography, X-Ray Computed - methods; Tumors; Young Adult
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2016.08.011

Abstract Objectives To evaluate the utility of perfusion CT (PCT) in differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis (MFCP). Methods In this ethically approved study, PCT was performed in 122 patients with pancreatic masses of which 42 patients had pancreatic adenocarcinoma and 13 had MFCP on histopathology. Perfusion parameters studied included blood flow (BF), blood volume (BV), permeability surface area product (PS), time to peak (TTP), peak enhancement intensity (PEI) and mean transit time (MTT). Twenty five controls with no pancreatic pathology were also studied. Results Amongst the perfusion parameters BF and BV were found to be the most reliable for differentiating between adenocarcinoma and mass forming pancreatitis. Although they were reduced in both pancreatic adenocarcinoma (BF- 16.6 ± 13.1 ml/100 ml/min and BV- 5 ± 3.5 ml/100 ml) and MFCP (BF- 30.4 ± 8.7 ml/100 ml/min and BV- 8.9 ± 3.1 ml/100 ml) as compared to normal controls (BF- 94.1 ± 24 ml/100 ml/min and BV- 36 ± 10.7 ml/100 ml) but the extent of reduction was greater in pancreatic adenocarcinoma than in MFCP. Based on ROC analysis cut off values of 19.1 ml/100 ml/min for BF and 5 ml/100 ml for BV yielded optimal sensitivity and specificity for differentiating pancreatic adenocarcinoma from MFCP. Conclusions PCT may serve as an additional paradigm for differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis and a useful tool for detecting masses which are isodense on conventional CT.