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CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2024; 07(01): 009-019
DOI: 10.1055/s-0043-1774298
Original Article

Utility of Contrast-Enhanced Computed Tomography for Differentiating Pancreatic Ductal Adenocarcinoma from Inflammatory Mass in Chronic Calcific Pancreatitis

Thara Pratap
1   Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
,
Dhanya Jacob
1   Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
,
Sudhakar K. Venkatesh
2   Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
,
Muhammed Jasim Abdul Jalal
3   Internal Medicine and Rheumatology, Olive Health Care, Thrissur, Kerala, India
,
Vishnu K. 
1   Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India
› Author Affiliations Funding None.
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Abstract

Objective The aim of this study was to identify the most useful contrast-enhanced computed tomography (CECT) features for differentiating pancreatic ductal adenocarcinoma (PDAC) from mass-forming chronic pancreatitis (MFCP) in chronic calcific pancreatitis (CCP).

Methods In total, 101 patients with CCP and focal pancreatic mass formed the study group. Sixteen qualitative and four quantitative parameters were analyzed. Qualitative parameters included size, site, margin, intralesional hypodensity, collateral duct sign, abrupt pancreatic duct (PD) cutoff, upstream PD dilatation, distal pancreatic atrophy, double duct sign, enhancement pattern, contrast attenuation, peripancreatic inflammation, vascular involvement, regional nodes, and metastasis. Quantitative parameters included duct-to-body ratio, common bile duct (CBD) diameter, main pancreatic duct (MPD) diameter, and carcinoembryonic antigen 19-9 (CA19-9). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for prediction of PDAC. A receiver operating characteristic (ROC) curve analysis was performed and the area under ROC curve (AUROC) was calculated to determine diagnostic accuracy to assess the optimal cutoff.

Results PDAC was confirmed in 48 patients and MFCP in 53 patients. A duct-to-body ratio greater than 0.48 had 95.5% sensitivity, 83.3% specificity, 80.8% PPV, 96.2% NPV, and 88.5% accuracy for predicting PDAC. A CBD diameter cutoff ≥9.5 mm had an accuracy of 75% (p < 0.019) and an MPD cutoff ≥6.25 mm had an accuracy of 67.8% (p = 0.008) for predicting PDAC. On binary logistic regression, the duct-to-body ratio was found to be the significant independent factor associated with malignancy.

Conclusion A duct-to-body ratio greater than 0.48, intralesional hypodensity, and abrupt duct cutoff are the most helpful computed tomography (CT) features for distinguishing PDAC from MFCP in CCP. On binary logistic regression, the duct-to-body ratio was found to be a significant independent factor. Interspersed normal parenchyma was observed as a very specific sign of MFCP. Intraparenchymal hypodensity has high specificity, but further validation is needed.

Keywords

pancreatic ductal carcinoma - inflammatory mass - chronic pancreatitis - pancreatic calcification

Compliance with Ethical Principles

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


Author Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by T.P., D.J., and V.K. The first draft of the manuscript was written by D.J., and all the authors commented on the previous versions of the manuscript. All the authors read and approved the final version of the manuscript.




Publication History

Article published online:
18 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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