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

Autor: O'Malley RB; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA. ryanomal@uw.edu., Cox D; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA., Soloff EV; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA., Zečević M; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA., Green S; Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA., Coveler A; Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA., Busey JM; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA., Wang CL; Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Box 357115, Seattle, WA, 98195, USA.
Jazyk: angličtina
Zdroj: Abdominal radiology (New York) [Abdom Radiol (NY)] 2022 Nov; Vol. 47 (11), pp. 3770-3781. Date of Electronic Publication: 2022 Aug 16.
DOI: 10.1007/s00261-022-03638-7
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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