Early Detection of Pancreatic Adenocarcinoma Using Triple-phase contrast-enhanced Computed Tomography: A Case-control Study
Tsuyoshi Hayashi, Yoshihisa Kodama, Yasuo Sakurai, Hajime Yamazaki, Yukiko Takigawa, Haruka Toyonaga, Tatsuya Ishii, Toshifumi Kin, Kuniyuki Takahashi, Akio KatanumaObjectives:
To investigate the imaging findings of the triple-phase computed tomography (CT), which was performed prior to definitive diagnoses in patients with Pancreatic ductal adenocarcinoma (PDAC).
Methods:
The single-center, retrospective, case-control study included patients with PDAC who underwent triple-phase CT 3–36 months prior to definitive diagnosis (pre-diagnostic CT) between January 2007 and March 2018 in Teine Keijinkai hospital. Triple-phase CT in sex- and age-matched patients without PDAC appearance in a 4:1 ratio were selected as controls. Findings were detected from each of the five divided pancreatic sections on pre-diagnostic CT by radiologists’ reviews, and were analyzed by comparison with CT at the definitive diagnosis (diagnostic CT) to investigate risk ratios.
Results:
Pre-diagnostic CTs were investigated in 190 and 760 sections with 38 PDAC and 152 control patients. In the diagnostic CT, 50 PDAC-positive and 900 negative sections were detected, respectively. In pre-diagnostic CT review, some findings were shown in 17 (34.0%) and 18 (2.0%) sections among PDAC-positive and negative sections, respectively, and the total number of findings was 46 and 28 in PDAC-positive and negative sections, respectively. Finally, different attenuation of pancreatic parenchyma in each phase, MPD stenosis, and focal pancreatic parenchymal atrophy were significantly correlated with the risk of PDAC.
Conclusions:
While some findings may already appear on the pre-diagnostic CT in one-third of the PDAC-positive sections, an accurate and detailed review in triple-phase CT is indispensable to detect early PDAC in clinical practice.