Surgically proved visually isoattenuating pancreatic adenocarcinoma undetected in both dynamic CT and MRI. Was blind pancreaticoduodenectomy justified?

Blouhos, Konstantinos; Tselios, Dimitrios G.; Katsaouni, Stavroula P.; Mauroeidi, Basiliki; Hatzigeorgiadis, Anestis

doi:10.1016/j.ijscr.2013.02.010

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Because pancreatic cancer frequently has an abundant fibrotic stroma, which is seen as a hypo-attenuating mass in the early arterial phase with progressive delayed enhancement 29 , 30 , we believe that the lower average observed on the pancreas phase images reflects pancreatic cancer with abundant desmoplastic reactions. Other studies have suggested that iso-attenuating pancreatic cancers on early-phase images tend to display less desmoplastic change within the mass and show better survival outcome 25 , 31 – 36 . Studies involving diffusion MRI have concluded that the degree of fibrosis in pancreatic cancer cases correlates with diffusion restrictions related to poor prognosis 37 , 38 and that it could be used to monitor treatment response 39 .…”

Section: Discussionmentioning

confidence: 98%

“…One of characteristic pathologic features of pancreas cancer is the presence of intense fibrosis in the tumor, which is known as desmoplastic reaction 21 . Previous studies have demonstrated that scirrhous carcinomas with abundant fibrosis and relative sparse tumor cells in the stomach, bile duct, breast, and colon have a poor prognosis 22 – 25 . Now the evidence is accumulating that the fibrous component of a tumor correlates with its malignant behavior and contribute to therapeutic resistance 26 .…”

Section: Discussionmentioning

confidence: 99%

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Tumor heterogeneity of pancreas head cancer assessed by CT texture analysis: association with survival outcomes after curative resection

Yun

Kim

Lee

et al. 2018

Sci Rep

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The value of image based texture features as a powerful method to predict prognosis and assist clinical management in cancer patients has been established recently. However, texture analysis using histograms and grey-level co-occurrence matrix in pancreas cancer patients has rarely been reported. We aimed to analyze the association of survival outcomes with texture features in pancreas head cancer patients. Eighty-eight pancreas head cancer patients who underwent preoperative CT images followed by curative resection were included. Texture features using different filter values were obtained. The texture features of average, contrast, correlation, and standard deviation with no filter, and fine to medium filter values as well as the presence of nodal metastasis were significantly different between the recurred (n = 70, 79.5%) and non-recurred group (n = 18, 20.5%). In the multivariate Cox regression analysis, lower standard deviation and contrast and higher correlation with lower average value representing homogenous texture were significantly associated with poorer DFS (disease free survival), along with the presence of lymph node metastasis. Texture parameters from routinely performed pre-operative CT images could be used as an independent imaging tool for predicting the prognosis in pancreas head cancer patients who underwent curative resection.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Tumor heterogeneity of pancreas head cancer assessed by CT texture analysis: association with survival outcomes after curative resection

Yun

Kim

Lee

et al. 2018

Sci Rep

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“…Multi-detector computed tomography (MDCT), during the phase of peak pancreatic enhancement (pancreatic parenchymal phase) has high diagnostic sensitivity for visualizing PDA >2 cm, but decreases in smaller lesions [2]. These small, sometimes isoattenuating, lesions may only demonstrate subtle secondary features such as pancreatic atrophy or pancreatic or biliary ductal dilation and therefore can be difficult to visualize and consequently manage [3, 4]. Such isoattenuating lesions are not infrequent on MDCT.…”

Section: Introductionmentioning

confidence: 99%

Quantitative and Qualitative Comparison of Single-Source Dual-Energy Computed Tomography and 120-kVp Computed Tomography for the Assessment of Pancreatic Ductal Adenocarcinoma

Bhosale¹,

Le²,

Balachandran³

et al. 2015

Journal of Computer Assisted Tomography

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Purpose To compare contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) between pancreatic phase dual-energy computed tomography (DECT) and 120 kVp CT for pancreatic ductal adenocarcinoma (PDA). Materials and Methods 78 patients underwent multiphasic pancreatic imaging protocols for PDA (40, DECT and 38, 120 kVp CT [control]). Using pancreatic phase, CNR and SNR for PDA were obtained for DECT at monochromatic energies (ME) 50 through 80 keV, iodine material density images (MDI), and 120 kVp images. Using a 5 point scale (1=excellent and 5=markedly limited) images were qualitatively assessed by two radiologist in consensus for PDA detection, extension, vascular involvement, and noise. Wilcoxon signed-rank and 2-sample tests were used to compare the qualitative measures, CNR, SNR for DECT and 120 kVp images. Bonferroni correction was applied. Results Iodine MDI had significantly higher CNR and SNR for PDA than any ME images (p<.0001) and the 120 kVp images. Qualitatively 70 keV images were rated highest in the categories of tumor extension and vascular invasion and were similar to 120kVp images. Conclusion Our results indicate that DECT improves PDA lesion conspicuity compared to routine 120 kVp CT which may allow for better detection of PDA.

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“…Although MR imaging is more vulnerable to the effect of motion and usually has lower spatial resolution than CT, its strength lies in its high-contrast resolution that is potentially useful for evaluating low-contrast SPLs ( 10 11 12 13 ). With recent advances in MRI technology, including higher field strength (3T), increasingly powerful multichannel coils, high resolution three-dimensional (3D) gradient-recalled echo (GRE) sequences and diffusion-weighted imaging (DWI), MRI may provide improved diagnostic accuracy for SPLs than before ( 14 15 16 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions

Choi

Lee

et al. 2016

Korean J Radiol

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ObjectiveTo compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs).Materials and Methods193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis.ResultsThe sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454).ConclusionMRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.

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Surgically proved visually isoattenuating pancreatic adenocarcinoma undetected in both dynamic CT and MRI. Was blind pancreaticoduodenectomy justified?

Abstract: When the above studies fail to unmask the lesion, blind pancreaticoduodenectomy should be based on strong clinical suspicion and secondary imaging findings.

Cited by 6 publications

References 11 publications

Tumor heterogeneity of pancreas head cancer assessed by CT texture analysis: association with survival outcomes after curative resection

Tumor heterogeneity of pancreas head cancer assessed by CT texture analysis: association with survival outcomes after curative resection

Quantitative and Qualitative Comparison of Single-Source Dual-Energy Computed Tomography and 120-kVp Computed Tomography for the Assessment of Pancreatic Ductal Adenocarcinoma

Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions

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