Early Detection of Pancreatic Adenocarcinoma Using Triple-phase contrast-enhanced Computed Tomography: A Case-control...

To investigate the imaging findings of the triple-phase computed tomography (CT), which was performed prior to definitive diagnoses in patients with Pancreatic ductal adenocarcinoma (PDAC).

The single-center, retrospective, case-control study included patients with PDAC who underwent triple-phase CT 3-36 months prior to definitive diagnosis (pre-diagnostic CT) between January 2007 and March 2018 in Teine Keijinkai hospital. Triple-phase CT in sex- and age-matched patients without PDAC appearance in a 4:1 ratio were selected as controls. Findings were detected from each of the five divided pancreatic sections on pre-diagnostic CT by radiologists' reviews, and were analyzed by comparison with CT at the definitive diagnosis (diagnostic CT) to investigate risk ratios.

Pre-diagnostic CTs were investigated in 190 and 760 sections with 38 PDAC and 152 control patients. In the diagnostic CT, 50 PDAC-positive and 900 negative sections were detected, respectively. In pre-diagnostic CT review, some findings were shown in 17 (34.0%) and 18 (2.0%) sections among PDAC-positive and negative sections, respectively, and the total number of findings was 46 and 28 in PDAC-positive and negative sections, respectively. Finally, different attenuation of pancreatic parenchyma in each phase, MPD stenosis, and focal pancreatic parenchymal atrophy were significantly correlated with the risk of PDAC.

While some findings may already appear on the pre-diagnostic CT in one-third of the PDAC-positive sections, an accurate and detailed review in triple-phase CT is indispensable to detect early PDAC in clinical practice.