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CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging

  • Pancreas
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the significance of CT perfusion parameters predicting response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma (PDAC).

Materials and methods

Seventy patients with PDAC prospectively had CT perfusion acquisition incorporated into baseline multiphase staging CT. Twenty-eight who were naïve to therapy were retained for further investigation. Perfusion was performed 5–42.5 s after contrast, followed by parenchymal and portal venous phases. Blood flow (BF), blood volume (BV), and permeability surface area product (PS) were calculated using deconvolution algorithms. Patients were categorized as responders or non-responders per RECIST 1.1. Perfusion variables with AUC ≥ 0.70 in differentiating responders from non-responders were retained. Logistic regression was used to assess associations between baseline perfusion variables and response.

Results

18 of 28 patients showed favorable response to therapy. Baseline heterogeneity variables in tumor max ROI were higher in non-responders than responders [median BF coefficient of variation (CV) 0.91 vs. 0.51 respectively, odds ratio (OR) 6.8 per one standard deviation (1-SD) increase, P = 0.047; median PS CV 1.6 vs. 0.68, OR 3.9 per 1-SD increase, P = 0.047; and median BV CV 0.75 vs. 0.54, OR = 4.0 per 1-SD increase, P = 0.047]. Baseline BV mean in tumor center was lower in non-responders than responders (median BV mean: 0.74 vs. 2.9 ml/100 g respectively, OR 0.28 per 1-SD increase, P = 0.047).

Conclusion

For patients with PDAC receiving neoadjuvant therapy, lower and more heterogeneous perfusion parameters correlated with an unfavorable response to therapy. Such quantitative information can be acquired utilizing a comprehensive protocol interleaving perfusion CT acquisition with standard of care multiphase CT scans using a single contrast injection, which could be used to identify surgical candidates and predict outcome.

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Data availability

All data generated or analyzed during the study are included in the published paper.

Abbreviations

PDAC:

Pancreatic ductal adenocarcinoma

ROI:

Region of interest

AUC:

Area under the receiver operating characteristic curve

IQR:

Interquartile range

CV:

Coefficient of variation

CT:

Computed tomography

BR:

Borderline resectable

LA:

Locally advanced

BV:

Blood volume

PS:

Permeability surface area product

BF:

Blood flow

TTP:

Time to peak concentration

CA:

Carbohydrate antigen

CTDIvol :

CT dose index

SSDE:

Size specific dose index

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Funding

This research was supported by GE Healthcare.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA

    Ryan B. O’Malley, Danielle Cox, Erik V. Soloff, Mladen Zečević, Janet M. Busey & Carolyn L. Wang

  2. Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA

    Steven Green & Andrew Coveler

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  1. Ryan B. O’Malley
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  2. Danielle Cox
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  3. Erik V. Soloff
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  4. Mladen Zečević
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Correspondence to Ryan B. O’Malley.

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O’Malley, R.B., Cox, D., Soloff, E.V. et al. CT perfusion as a potential biomarker for pancreatic ductal adenocarcinoma during routine staging and restaging. Abdom Radiol 47, 3770–3781 (2022). https://doi.org/10.1007/s00261-022-03638-7

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