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Extracellular volume fraction determined by equilibrium contrast-enhanced dual-energy CT as a prognostic factor in patients with stage IV pancreatic ductal adenocarcinoma

  • Yoshihiko FukukuraEmail author
  • Yuichi Kumagae
  • Ryutaro Higashi
  • Hiroto Hakamada
  • Masatoyo Nakajo
  • Kosei Maemura
  • Shiho Arima
  • Takashi Yoshiura
Computed Tomography
  • 50 Downloads

Abstract

Objectives

To evaluate the feasibility of equilibrium contrast-enhanced dual-energy CT (DECT), as compared with single-energy CT (SECT) and to calculate extracellular volume (ECV) fraction to predict the survival outcomes of pancreatic ductal adenocarcinoma (PDAC) patients with distant metastases (stage IV) treated with chemotherapy.

Methods

The study cohort included a total of 66 patients with stage IV PDAC who underwent DECT before systemic chemotherapy between July 2014 and March 2017. Unenhanced and 120-kVp equivalent images during the equilibrium phase were used to calculate tumor SECT-derived ECV fractions, and iodine density images were obtained from equilibrium-phase DECT for DECT-derived ECV fractions. Correlations between SECT- and DECT-derived ECV fractions were identified using the Pearson correlation coefficient and Bland–Altman analysis. The effects of clinical prognostic factors and tumor SECT- and DECT-derived ECV fractions on progression-free survival (PFS) and overall survival (OS) were assessed by univariate and multivariate analyses using Cox proportional hazards models.

Results

The correlation between SECT- and DECT-derived ECV fractions was strong (r = 0.965; p < 0.001). The Bland–Altman plot between SECT- and DECT-derived ECV fractions showed a small bias (− 3.4%). Increasing tumor SECT- and DECT-derived ECV fractions were associated with a positive effect on PFS (SECT, p = 0.002; DECT, p = 0.007) and OS (DECT, p = 0.014; DECT, p = 0.015). Only tumor DECT-derived ECV fraction was an independent predictor of PFS (p = 0.018) and OS (p = 0.022) in patients with stage IV PDAC treated with chemotherapy on multivariate analysis.

Conclusions

The ECV fraction determined by equilibrium contrast-enhanced DECT can potentially predict the survival of patients with stage IV PDAC treated with chemotherapy.

Key Points

• Extracellular volume fraction of stage IV pancreatic ductal adenocarcinoma determined by dual-energy CT was strongly correlated to that with single-energy CT (r = 0.965, p < 0.001).

• Tumor extracellular volume fraction was an independent predictor of progression-free survival (p = 0.018) and overall survival (p = 0.022).

• Extracellular volume fraction determined by dual-energy CT could be a useful imaging biomarker to predict the survival of patients with stage IV pancreatic ductal adenocarcinoma treated with chemotherapy.

Keywords

Pancreatic ductal carcinoma Multidetector computed tomography Contrast media Extracellular space Treatment outcome 

Abbreviations

CA

Carbohydrate antigen

CEA

Carcinoembryonic antigen

CI

Confidence interval

CTDIvol

CT dose index volume

DECT

Dual-energy CT

DLP

Dose-length product

ECV

Extracellular volume

ICC

Intraclass correlation coefficient

IDI

Iodine density image

OS

Overall survival

PDAC

Pancreatic ductal adenocarcinoma

PFS

Progression-free survival

ROIs

Regions of interest

SECT

Single-energy CT

UICC

Union for International Cancer Control

Notes

Funding Information

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Yoshihiko Fukukura, MD, PhD, Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshima CityJapan
  2. 2.Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshima CityJapan
  3. 3.Department of Digestive and Lifestyle Diseases, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshima CityJapan

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