Extracellular volume fraction determined by dual-layer spectral detector CT: Possible role in predicting the efficacy of preoperative neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma. Issue 162 (May 2023)

• Record Type: Journal Article
• Authors: Fujita, Nobuhiro; Ushijima, Yasuhiro; Itoyama, Masahiro; Okamoto, Daisuke; Ishimatsu, Keisuke; Wada, Noriaki; Takao, Seiichiro; Murayama, Ryo; Fujimori, Nao; Nakata, Kohei; Nakamura, Masafumi; Yamamoto, Takeo; Oda, Yoshinao; Ishigami, Kousei
• Is Part Of: European journal of radiology. Issue 162(2023)
• Publication Date: 2023-05
• Subjects: Pancreatic ductal adenocarcinoma -- Dual-energy CT -- Extracellular volume -- Neoadjuvant chemotherapy; PDAC Pancreatic ductal adenocarcinoma -- R-PDAC resectable pancreatic ductal adenocarcinoma -- BR-PDAC borderline resectable pancreatic ductal adenocarcinoma -- NAC neoadjuvant chemotherapy -- SECT single-energy CT -- DECT dual-energy CT -- ECV extracellular volume -- ROI region of interest -- GnP gemcitabine plus nab-paclitaxel -- GS gemcitabine plus tegafur/gimeracil/oteracil -- FOLFIRINOX, fluorouracil leucovorin, irinotecan, and oxaliplatin -- ICC intraclass correlation coefficient -- CI confidence interval -- CAFs cancer-related fibroblasts; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2023.110756
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Purpose: To clarify the relationship between extracellular volume (ECV) measured by dual-energy CT (DECT) and efficacy of preoperative neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC), as compared with single-energy CT (SECT). Methods: We enrolled 67 patients with PDAC who underwent dynamic contrast-enhanced CT with a dual-energy CT system prior to NAC. Attenuation values were measured on unenhanced and the equilibrium-phase 120-kVp equivalent CT images for PDAC and the aorta. ΔHU-tumor, ΔHU-tumor/ΔHU-aorta, and SECT-ECV were calculated. Iodine densities of the tumor and aorta were measured in the equilibrium phase, and DECT-ECV of the tumor was calculated. Response to NAC was evaluated and the correlation between imaging parameters and response to NAC was statistically assessed. Results: Tumor DECT-ECVs were significantly lower in the response group (n = 7) than in the non-response group (n = 60), with most significant difference (p = 0.0104). DECT-ECV showed highest diagnostic value with an Az value of 0.798. When using the optimal cut off value of DECT-ECV (<26.0 %), sensitivity, specificity, accuracy, positive predictive value, and negative value for predicting response group were 71.4 %, 85.0 %, 83.6 %, 35.7 % and 96.2 %, respectively. Conclusion: PDAC with lower DECT-ECV can potentially show better response to NAC. DECT-ECV might be a useful biomarker for predicting response to NAC in patients with PDAC.