Development of pancreatic cancer is predictable well in advance using contrast-enhanced CT: a case-cohort study.
Eur Radiol. 2017 Jun 19. doi: 10.1007/s00330-017-4895-8. [Epub ahead of print] Gonoi W1, Hayashi TY2, Okuma H2, Akahane M2,3, Nakai Y4, Mizuno S4, Tateishi R4, Isayama H4, Koike K4, Ohtomo K2.
OBJECTIVES: To investigate the radiological findings prognostic for the development of pancreatic adenocarcinoma in a cohort of patients with hepatocellular carcinoma, using multiphasic computed tomography (CT).
METHODS: A case-cohort study performed in a single university hospital. A database of patients who received hepatocellular carcinoma (HCC) treatment and trimonthly follow-up with four-phase dynamic CT was used (n = 1848). The cohort group was randomly extracted from the database (n = 103). The case group comprised nine patients from the database who developed pancreatic adenocarcinoma. The radiological findings were assessed during follow-up (average, 32 months).
RESULTS: The incidence of pancreatic mass, inhomogeneous parenchyma, loss of fatty marbling and main pancreatic duct dilatation gradually increased from 4 to 13 months before the diagnosis of pancreatic adenocarcinoma. There was a significantly higher incidence of pancreatic mass, inhomogeneous parenchyma and loss of fatty marbling on CT at baseline (average, 34 months before diagnosis) in the case group compared with the cohort group (P values < 0.01) and those findings at baseline were revealed as prognostic factors for pancreatic carcinogenesis, respectively (log-rank test, P values < 0.001).
CONCLUSIONS: Several radiological findings observed on multiphasic CT can assist in predicting pancreatic carcinogenesis well in advance. KEY POINTS: • Pancreatic findings in multiphasic CT help predict development of pancreatic adenocarcinoma. • Key findings are mass, inhomogeneous parenchyma and loss of fatty marbling. • Those findings were observed 34 months before confirmed diagnosis of adenocarcinoma. • Those findings were prognostic factors for pancreatic carcinogenesis.