Contrast-enhanced photon-counting detector CT for discriminating local recurrence from postoperative changes after resection of pancreatic ductal adenocarcinoma

• DOI: 10.1186/s41747-025-00567-0
• Publication Date: 2025-02-22T15:17:36Z
• Authors: Zlatan Alagic; Carlos Valls Duran; Anders Svensson-M...; Seppo K. Koskinen
• Keywords: Medical physics. Medical radiology. Nuclear medicine; Sensitivity and specificity; Neoplasm recurrence (local); R895-920; Carcinoma (pancreatic ductal); Tomography (x-ray computed); Logistic models

Abstract Background We evaluated the diagnostic capability of photon-counting detector computed tomography (PCD-CT) spectral variables in late arterial phase (LAP) and portal venous (PVP) to discriminate between local tumor recurrence (LTR) postoperative changes (POC) after pancreatic ductal adenocarcinoma (PDAC) resection. Methods Seventy-three consecutive PCD-CT scans 73 patients with soft-tissue lesions (PSLs) were included, 42 POC 31 LTR. Regions interest drawn each PSL, calculated: iodine concentration (IC), normalized IC (NIC), fat fraction, attenuation at 40, 70, 90 keV, slope curve 40–90 keV. Multivariable binary logistic regression models constructed. Diagnostic performance was assessed for LAP PVP using receiver operating characteristic analysis. Results In LAP, all except fraction showed significant differences LTR ( p ≤ 0.025). PVP, NIC demonstrated 0.005). Logistic analysis included 70 keV LAP-based model PVP-based model. Both achieved a higher area under (AUC) than individual phase. The an AUC 0.919 94% sensitivity, 84% specificity, 87% accuracy, while reached 0.820, 71%, 88%, 81%, respectively. Conclusion Spectral from help distinguish post-PDAC improves performance, especially LAP. Relevance statement Measuring phase, or incorporating these values into can differentiate Key Points Distinguishing on CT resection is challenging. variable differed significantly (POC). POC. phase-based sensitivity specificity. Graphical