Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2020; 26(28): 4151-4158
Published online Jul 28, 2020. doi: 10.3748/wjg.v26.i28.4151
Enhancement parameters of contrast-enhanced computed tomography for pancreatic ductal adenocarcinoma: Correlation with pathologic grading
Woorim Seo, Young Chul Kim, Seon Jeong Min, Sang Min Lee
Woorim Seo, Young Chul Kim, Seon Jeong Min, Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do 18450, South Korea
Sang Min Lee, Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
Author contributions: All the authors solely contributed to this paper; Kim YC, Seo W, Min SJ, and Lee SM substantially contributed to conception and design of the study, acquisition of data, or analysis and interpretation of data; Kim YC and Seo W contributed to drafting the article or making critical revisions related to important intellectual content of the manuscript; Kim YC, Min SJ and Lee SM finally approved of the version of the article to be published.
Supported by Central Medical Service Research Fund.
Institutional review board statement: The study was approved by the Hallym University Dongtan Sacred Heart Hospital ethics committee.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Young Chul Kim, MD, Associate Professor, Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Gyeonggi-do 18450, South Korea.
Received: April 6, 2020
Peer-review started: April 6, 2020
First decision: April 26, 2020
Revised: May 8, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: July 28, 2020

Pancreatic ductal adenocarcinoma (PDA) is a malignancy with a high mortality rate and short survival time. The conventional computed tomography (CT) has been worldwide used as a modality for diagnosis of PDA, as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.


To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.


In this retrospective study, 42 patients (Age, mean ± SD: 62.43 ± 11.42 years) with PDA who underwent surgery after preoperative CT were selected. Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase (VAarterial and VApancreatic) and of the tumor (VTarterial and VTpancreatic) by finding out four regions of interest. Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase (TARarterial and TARpancreatic) was figured out through dividing VTarterial by VAarterial and VTpancreatic by VApancreatic. Tumor-to-aortic enhancement fraction (TAF) was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images. The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.


Forty-two PDAs (23 men and 19 women) were divided into three groups: Well-differentiated (n = 13), moderately differentiated (n = 21), and poorly differentiated (n = 8). TAF differed significantly between the three groups (P = 0.034) but TARarterial (P = 0.164) and TARpancreatic (P = 0.339) did not. The median value of TAF for poorly differentiated PDAs (0.1011; 95%CI: 0.01100-0.1796) was significantly higher than that for well-differentiated PDAs (0.1941; 95%CI: 0.1463-0.3194).


Calculation of TAF might be useful in predicting the pathologic grade of PDA.

Keywords: Computed tomography, Pancreatic ductal carcinoma, Diagnostic imaging, Clinical pathology, Neoplasm grading, Prognosis

Core tip: The conventional computed tomography (CT) has been worldwide used as a modality for diagnosis of pancreatic ductal adenocarcinoma (PDA). In this study, the tumor-to-aortic enhancement fraction (TAF) values were statistically different among the well differentiated group, the moderately differentiated group and the poorly differentiated group (P < 0.05). It has been reported that TARarterial and TARpancreatic are related to histological finding of PDA, but in our study. there were no significant differences in TARarterial and TARpancreatic among the three groups. TAF can be obtained with conventional pancreatic CT, without additional radiation exposure and processing time, and this simple method could be useful for predicting prognosis of PDA.