Detection of small (≤ 2 cm) pancreatic adenocarcinoma and surrounding parenchyma: correlations between enhancement patterns at triphasic MDCT and histologic features
1 Department of Surgical, Radiological and Odontostomatological Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia 06134, Italy
2 Department of Surgical, Radiological and Odontostomatological Sciences, Thoracic Surgery, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy
3 Complex Structure of General Surgery 2, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy
4 Department of Pathology, S. Maria del Carmine Rovereto Hospital, Rovereto, Italy
5 Division of Radiology, Budrio Hospital, ASL Budrio, Bologna, Italy
6 Department of Radiology, University Hospital of Parma, Parma, Italy
7 Division of Radiology, San Giuseppe Moscati Hospital, Aversa, Caserta, Italy
8 Department of Radiology, University of Molise, C.da Tappino, Campobasso, Italy
9 Department of Experimental and Clinical Internistic, F. Magrassi- A. Lanzara, Second University of Naples, Naples, Italy
BMC Gastroenterology 2014, 14:16 doi:10.1186/1471-230X-14-16Published: 21 January 2014
The aim is to assess the time-density curves (TDCs) and correlate the histologic results for small (≤ 2 cm) PDA and surrounding parenchyma at triphasic Multidetector-row CT (MDCT).
Triphasic MDCT scans of 38 consecutive patients who underwent surgery for a small PDA were retrospectively reviewed. The TDCs were analyzed and compared with histologic examination of the PDA and pancreas upstream/downstream in all cases. Three enhancement patterns were identified: 1) enhancement peak during pancreatic parenchymal phase (PPP) followed by a rapid decline on portal venous phase (PVP) and delayed phase (DP) at 5 minutes (type 1 pattern: normal pancreas); 2) maximum enhancement in PVP that gradually decreases in DP (type 2 pattern: mild chronic pancreatitis or PDA with mild fibrous stroma); 3) progressive enhancement with maximum peak in DP (type 3 pattern: severe chronic pancreatitis or PDA with severe fibrous stroma). A p value less than 0.05 was considered statistically significant. Sensitivity was calculated for PDA detection and an attenuation difference with the surrounding tissue of at least 10 HU was considered.
PDA showed type 2 pattern in 5/38 cases (13.2%) and type 3 pattern in 33/38 cases (86,8%). Pancreas upstream to the tumor had type 2 pattern in 20/38 cases (52,6%) and type 3 pattern in 18/38 cases (47,4%). Pancreas downstream to the tumor had type 1 pattern in 19/25 cases (76%) and type 2 pattern in 6/25 cases (24%). Attenuation difference between tumor and parenchyma upstream was higher of 10 UH on PPP in 31/38 patients (sensitivity = 81.6%), on PVP in 29/38 (sensitivity = 76.3%) and on DP in 17/38 (sensitivity = 44.7%). Attenuation difference between tumor and parenchyma downstream was higher of 10 UH on PPP in 25/25 patients (sensitivity = 100%), on PVP in 22/25 (sensitivity = 88%) and on DP in 20/25 (sensitivity = 80%). Small PDAs were isodense to the pancreas upstream to the tumor, and therefore unrecognizable, in 8 cases (8/38; 21%) at qualitative analysis and in 4 cases (4/38; 10,5%) at quantitative analysis.
The quantitative analysis increases the sensitivity for detection of small PDA at triphasic MDCT.