The value of preoperative 18F-fluorodeoxyglucose PET/computed tomography combined with contrast-enhanced computed tomography for assessing the resectability of pancreatic ductal adenocarcinoma

Objective The objective of the study is to investigate the value of preoperative 18 F-fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) combined with contrast-enhanced CT (CECT) for predicting negative resection (R0) in pancreatic ductal adenocarcinoma (PDAC). Materials and methods This retrospective study included patients with PDAC who underwent surgical exploration/resection and received both preoperative 18 F-FDG PET/CT and CECT. Resection margin status was determined histopathologically and categorized as R0 versus non-R0 (R1/R2). Clinical variables, CECT features, and PET/CT parameters [including metabolic tumor volume (MTV) and total lesion glycolysis] were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of R0 resection. Diagnostic performance was evaluated using receiver operating characteristic analysis. Vascular invasion was assessed using intraoperative findings as the reference. Results A total of 48 patients (mean age: 61 years; 31 men) were included; 27 (56.25%) achieved R0 resection. Univariate analysis identified tumor shape, tumor width, tumor height, MTV, and total lesion glycolysis as significant predictors. On multivariate analysis, MTV remained an independent predictor and showed the highest diagnostic performance for R0 resection (area under the curve = 0.854). For vascular invasion, the diagnostic accuracy of CECT and MTV was 93.0 and 84.6%, respectively. Conclusion Preoperative 18 F-FDG PET/CT provides additional value in predicting R0 resection in PDAC. MTV is an independent imaging predictor and may aid assessment of vascular invasion when interpreted in combination with CECT.