Feasibility of wide detector CT perfusion imaging performed during routine staging and restaging of pancreatic ductal adenocarcinoma

Abstract

To evaluate the feasibility of CT perfusion performed during routine multiphasecontrast-enhancedCTon a160mm wide-coverage256-slice scanner in patients with pancreatic ductal adenocarcinoma (PDAC). Fifty-seven patients had aCT perfusion acquisitionduringtheirroutine multiphase CT.Perfusion was performed 5 to 42.5s (15 passes at 2.5s intervals)after intravenous contrastadministration (4.2-5ml/s), followed by pancreatic parenchymal and portal venous phases for clinical interpretation. Perfusion maps were generated andblood flow (BF), blood volume (BV), and permeability surface area product (PS) for tumor and uninvolved pancreas were calculated using deconvolution algorithms and compared to existing similar publications. Radiationdose informationwas recorded and size-specific dose estimate (SSDE)was calculatedusing body dimensions. Diagnostic quality of standard images was unaffected by performing the perfusion acquisition. Average tumor center BF was 20.8 ± 12.1ml/100g/min, BV 2.5 ± 2.1ml/100g and PS 15.5 ± 39.4ml/100g/min. Average pancreas BF was 90.8 ± 50.2ml/100g/min, BV 11.9 ± 4.3ml/100g and PS 33.6 ± 27.7ml/100g/min. For the perfusion acquisition, meanSSDE was 57 ± 11mGy,CTDIvol43 ± 6mGyandDLP 685 ± 100mGy-cm. Adding a perfusion CT acquisition to standard pancreatic CTprotocol is feasible using a wide-detector 256-slice CT scanner and adds quantitative information while maintaining diagnostic quality of the standard of care examination.This novel protocol adds no time or cost to the examination and yields perfusion parameters that are comparable to existing literature using a separate dedicated perfusion protocol.