Dynamic Computed Tomography at Patients with Pancreatic Cancer. Perfusion Analysis in the Tumor and Pancreatic Parenchyma
Abstract
The aim was to analyze CT-perfusion of adenocarcinoma and pancreatic parenchyma outside the tumor. Material and methods. We examined 12 patients with histologically verificated pancreatic adenocarcinoma and 25 patients that hasn’t any pathology of pancreas. Perfusion CT was performed at 320-slice CT. Perfusion parameters were calculated with maximum slope method. Results. There were no significant differences found between perfusion characteristics of pancreatic head, body and tail. Also, we didn’t found significant differences in perfusion of visually not altered pancreatic parenchyma between patients with tumor and patients without any pathology of the pancreas. Perfusion of tumor was significantly lower than perfusion of visually not altered pancreas (64 ± 32 vs 115 ± 34 ml/100 ml/min; p < 0.05). Accordingly to perfusion changes tumor can be divided into three parts: superficial zone of decreased blood flow not correlating with the distance from tumor border, zone where we can see gradual centripetal decreasing of blood flow and central zone of the most altered perfusion without centripetal decreasing of blood flow. Conclusion. With PCT we can get additional characteristics of tumor which can be helpful in understanding of tumor pathogenesis.
About the Authors
Denis Valerievich Nesterov
Russian Scientific Center of Radiology and Surgical Technologies
Russian Federation
Russian Federation
Evgenij Vladimirovich Rozengauz
Russian Scientific Center of Radiology and Surgical Technologies; I.I. Mechnikov North-Western State Medical University
Russian Federation
Russian Federation
References
1. Catalano С., Laghi A., Fraioli F. et al. Pancreatic carcinoma: the role of high-resolution multislice spiral СТ in the diagnosis and assessment of resectability. Eur. Radiol. 2003; 13 (1): 149-156.
2. Megibow A.J. Pancreatic adenocarcinoma: designing the examination to evaluate the clinical questions. Radiology. 1992; 183 (2): 297-303.
3. Ichikawa T, Haradome H., Hachiya J. et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical СТ versus dynamic MR imaging. Radiology. 1997; 202 (3): 655-662.
4. Prokesch R.W., Chow L.C., Beaulieu C.F et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row СТ: secondary signs. Radiology. 2002; 224 (3): 764-768.
5. Ogawa H., Itoh S., Ikeda M. et al. Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection СТ. Radiology. 2008; 248 (3): 876-886.
6. Low G., Panu A., Millo N. et al. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 2011; 31 (4): 993-1015.
7. Bronstein Y.L., Loyer E.M., Kaur H. et al. Detection of small pancreatic tumors with multiphasic helical СТ. Am. J. Roentgenol. 2004; 182 (3): 619-623.
8. Kim J.H., Park S.H., Yu E.S. et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced СТ: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010; 257 (1) : 87-96.
9. Miles K.A. Functional computed tomography in oncology. Eur. J. Cancer Oxf. Engl. 1990. 2002; 38 (16): 2079-2084.
10. Miles K.A. Perfusion СТ: a worthwhile enhancement? Br. J. Radiol. 2003; 76: 220-231.
11. Miles K.A. Perfusion СТ for the assessment of tumour vascularity: which protocol? Br. J. Radiol. 2003; 76: S36-S42.
12. Axel L. Cerebral blood flow determination by rapidsequence computed tomography: theoretical analysis. Radiology. 1980; 137 (3): 679-686.
13. Bize P.E., Platon A., Becker C.D. et al. Perfusion measurement in acute pancreatitis using dynamic perfusion MDCT. Am. J. Roentgenol. 2006; 186 (1): 114-118.
14. D’ Assignies G., Couvelard A., Bahrami S. et al. Pancreatic endocrine tumors: tumor blood flow assessed with perfusion СТ reflects angiogenesis and correlates with prognostic factors. Radiology. 2009; 250 (2): 407-416.
15. Tsushima Y., Miyazaki M., Taketomi-Takahashi A. et al. Feasibility of measuring human pancreatic perfusion in vivo using imaging techniques. Pancreas. 2011; 40 (5): 747-752.
16. Xu J., Liang Z., Hao S. et al. Pancreatic adenocarcinoma: dynamic 64-slice helical CT with perfusion imaging. Abdom. Imaging. 2009; 34 (6): 759-766.
17. Klau M., Stiller W., Fritz F. et al. Computed tomography perfusion analysis of pancreatic carcinoma. J. Comput. Assist. Tomogr. 2012; 36 (2): 237-242.
18. Klauss M., Stiller W., Pahn G. et al. Dual-energy perfusion-CT of pancreatic adenocarcinoma. Eur. J. Radiol. 2013; 82 (2) : 208-214.
19. Takagi K., Takada Т., Amano H. et al. Analysis of microvessels in pancreatic cancer: by light microscopy, confocal laser scan microscopy, and electron microscopy. J. Hepatobiliary. Pancreat. Surg. 2008; 15 (4): 384-390.
20. Nanashima A., Shibata K., Nakayama T. et al. Relationship between microvessel count and clinicopathological characteristics and postoperative survival in patients with pancreatic carcinoma. Hepatogastroenterology. 2012; 59 (118): 1964-1969.
21. Barau A., Ruiz-Sauri A., Valencia G. et al. High microvessel density in pancreatic ductal adenocarcinoma is associated with high grade. Virchows Arch. Int. J. Pathol. 2013; 462 (5): 541-546.
22. Lu N., Feng X.-Y., Hao S.-J. et al. 64-slice CT perfusion imaging of pancreatic adenocarcinoma and mass-forming chronic pancreatitis. Acad. Radiol. 2011; 18 (1): 81-88.
Review
For citations:
Nesterov D.V., Rozengauz E.V. Dynamic Computed Tomography at Patients with Pancreatic Cancer. Perfusion Analysis in the Tumor and Pancreatic Parenchyma. Medical Visualization. 2014;(2):68-74. (In Russ.)
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