Evaluation of Texture Analysis for the Differential Diagnosis of Mass-Forming Pancreatitis From Pancreatic Ductal Adenocarcinoma on Contrast-Enhanced CT Images.

Shuai Ren,Xiao Chen,Rong Chen,Wenjing Cui,Shaofeng Duan,Jingya Chen,Rui Zhao,Zhongqiu Wang,Jingjing Zhang,Wenli Qiu

doi:10.3389/fonc.2019.01171

Abstract

Purpose: To investigate the potential of computed tomography (CT) imaging features and texture analysis to differentiate between mass-forming pancreatitis (MFP) and pancreatic ductal adenocarcinoma (PDAC).Materials and Methods: Thirty patients with pathologically proved MFP and 79 patients with PDAC were included in this study. Clinical data and CT imaging features of the two lesions were evaluated. Texture features were extracted from arterial and portal phase CT images using commercially available software (AnalysisKit). Multivariate logistic regression analyses were used to identify relevant CT imaging and texture parameters to discriminate MFP from PDAC. Receiver operating characteristic curves were performed to determine the diagnostic performance of predictions.Results: MFP showed a larger size compared to PDAC (p = 0.009). Cystic degeneration, pancreatic ductal dilatation, vascular invasion, and pancreatic sinistral portal hypertension were more frequent and duct penetrating sign was less frequent in PDAC compared to MFP. Arterial CT attenuation, arterial, and portal enhancement ratios of MFP were higher than PDAC (p < 0.05). In multivariate analysis, arterial CT attenuation and pancreatic duct penetrating sign were independent predictors. Texture features in arterial phase including SurfaceArea, Percentile40, InverseDifferenceMoment_angle90_offset4, LongRunEmphasis_angle45_offset4, and uniformity were independent predictors. Texture features in portal phase including LongRunEmphasis_angle135_offset7, VoxelValueSum, LongRunEmphasis_angle135_offset4, and GLCMEntropy_angle45_offset1 were independent predictors. Areas under the curve of imaging feature-based, texture feature-based in arterial and portal phases, and the combined models were 0.84, 0.96, 0.93, and 0.98, respectively.Conclusions: CT texture analysis demonstrates great potential to differentiate MFP from PDAC.

Highlights

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with a grim overall prognosis; its mortality is almost equal to its morbidity [1]
Pancreatic ductal dilatation, vascular invasion, and pancreatic sinistral portal hypertension were more frequent and duct penetrating sign was less frequent in PDAC compared to Mass-forming pancreatitis (MFP)
Arterial computed tomography (CT) attenuation, arterial, and portal enhancement ratios of MFP were higher than PDAC (p < 0.05)

Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with a grim overall prognosis; its mortality is almost equal to its morbidity [1]. Effective and non-invasive screening methods to detect PDAC at an early stage are of utmost importance. This may help to increase the survival rate by providing a chance for early surgical treatment and adjuvant intervention [3, 4]. Mass-forming pancreatitis (MFP) encompasses a gradual form of the ordinary chronic pancreatitis or a specific etiology such as focal type of autoimmune pancreatitis [5, 6], which must be differentiated accurately from PDAC due to their similar presentations of abdominal pain, weight loss, pancreatic insufficiency, and overlapping radiologic features [7,8,9,10,11]. Accurate preoperative differentiation between MFP and PDAC is clinically important for deciding whether or not to perform resection [12]. Non-invasive imaging is crucial in the differential diagnosis and treatment strategy planning

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