Dynamic volume perfusion CT for preoperative multidimensional resectability assessment of pancreatic ductal adenocarcinoma

Objective: The aim of this study was to evaluate the performance of dynamic volume perfusion computed tomography (dVPCT) in the preoperative multidimensional assessment of resectability in patients with pancreatic ductal adenocarcinoma (PDAC). Methods: We retrospectively collected clinical data from 53 patients with pathologically confirmed PDAC who underwent preoperative epigastric dVPCT. By performing morphological reconstruction, we assessed the degree of involvement of major peripancreatic vessels and compared the predicted resectability status of PDAC lesions against the records from surgical explorations. CT perfusion parameters, including blood flow (BF), blood volume (BV), surface permeability (PS), and mean transit time (MTT), were measured for each patient diagnosed with PDAC. Patients were categorized into resectable and unresectable groups on the basis of the operative findings, and differences in perfusion parameters between these groups were compared via the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was conducted to establish threshold values and areas under the curve (AUCs) for each perfusion parameter as predictors of PDAC resectability. Results: The sensitivity, specificity, positive prediction value, negative prediction value and accuracy of dVPCT for the diagnosis of peripancreatic arterial invasion were 88.2%, 100%, 100%, 97.8%, and 98.1%, respectively, whereas those for venous invasion were 88.9%, 98.9%, 94.1%, 97.8%, and 97.2%, respectively. For assessing the resectability of PDAC, dVPCT demonstrated a sensitivity of 88.5%, a specificity of 92.6%, a positive predictive value of 92.0%, a negative predictive value of 89.3%, and an accuracy of 90.6%. BF and BV values were significantly lower in the unresectable PDAC group than in the resectable group. The cutoff value for BF for diagnosing resectable PDAC was determined to be 49.9 mL/100 mL/min, with an AUC of 0.732 (95% confidence interval [CI]: 0.593-0.871).Similarly, the cutoff value for BV for the diagnosis of resectable PDAC was 4.3 mL/100 mL, yielding an AUC of 0.714 (95% CI: 0.575-0.853). Conclusion: Our preliminary study demonstrated that dVPCT permits the simultaneous acquisition of both high-quality morphological images and stable perfusion parameters for PDAC evaluation. These findings suggest that in cases of morphologically uncertain resectability, the derived perfusion parameters may provide complementary information and could serve as adjunctive tools to conventional imaging.