Diagnostic accuracy of perfusion-CT using Peak Enhancement Intensity (PEI) in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard.

Abstract

Pancreatic ductal carcinoma is the most common primary malignancy of the pancreas and is associated with a very poor prognosis, being worldwide one of the leading cause of cancer related death. The pre-operative correct identification of this group of patients is very important to minimize unnecessary resections but remains difficult owing to the post-operative assessment of some factors such as tumor resection margins and grading. Perfusion CT (P-CT) is a new imaging technique able to provide qualitative and quantitative information on perfusion parameters of tissues, which have been demonstrated to be correlated with histological markers of angiogenesis. Objectives: To estimate the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard. Study Design: Cross sectional study. Setting: Radiology department of Allied Hospital Faisalabad. Period: 6 months after approval from June, 2016 to Nov, 2016. Material and Methods: Permission for research was sought from hospital ethical committee. Patients were collected from OPD & indoor of Radiology and surgical department of Allied Hospital Faisalabad. Confounding variables were controlled by restriction (by excluding the subjects with history of metastatic disease or chemotherapy). CT-Perfusion examination was performed with the patient in supine position on a 128 slice Optima Multi detector CT scanner. Image guided (CT guided) biopsy was done on all patients and specimen was sent to the hospital pathology lab and histopathology was done by senior pathologist, who kept blinded to perfusion-CT analysis. Results: In this study, out of 100 cases, the diagnostic accuracy of CT perfusion using PEI in detecting high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard was recorded as 90.59%, 91.49%, 92.31%, 89.58% and 91% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: We concluded that diagnostic accuracy of CT perfusion using PEI is higher in detection of high grade pancreatic ductal adenocarcinoma keeping histopathology as gold standard.