Table A1.
Overview of included studies: Primary diagnosis and staging.
| Primary Diagnosis and Staging (All Studies were Prospective) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Authors, Publication Year | No. of Patients | Diagnosis | Scan Parameters | Kinetic Model | Aim | Gold Standard | Results | Conclusion | ||
| Slice | Contrast | kV and mAs | ||||||||
| D’Assignies et al. 2008 [18] | 28 | Pancreatic endocrine tumors | 64 | 40 mL | 100 kV, 100 mAs | Deconvolution/distributed parameter model | To correlate perfusion measurement with MVD and to determine whether perfusion parameters differ between tumor grades. | Histology, MVD, and WHO 2000 criteria † | Pancreatic endocrine tumors: BF tended to be higher in tumors than in pancreatic tissue outside of tumor (p < 0.06). Correlation with MVD: Tumor BF correlated with MVD (p < 0.001). Correlation with WHO: Significantly higher BF in WHO 1 tumors, than in WHO 2 and WHO 3 tumors (p = 0.02). | DCE-CT is feasible in patients with pancreatic endocrine tumors and allows evaluation of tumor angiogenesis. |
| Delrue et al. 2011 [19] | 40 | Pancreatic adenocarcinoma (n = 20) Normal pancreas in healthy volunteers (n = 20) | 128 Dual-source CT | 50 mL | 100 kV, 145 mAs | Maximum slope (single-compartment) | To assess perfusion characteristics in patients with pancreatic adenocarcinoma and to compare with values in normal healthy pancreatic tissue. | Histology | Pancreatic adenocarcinoma: Significantly lower BF, BV, and PS in the tumor center than in tumor rim and in pancreatic tissue outside of tumor (p < 0.05). Healthy volunteers: No significant differences in BF, BV, or PS in the different regions of the pancreas. Comparison-Patients with pancreatic adenocarcinoma and healthy volunteers: Significantly lower BF, BV, and PS in the tumor center compared with normal pancreatic tissue in healthy volunteers (p = 0.01). | DCE-CT provides added value when investigating tumor vascularization in pancreatic adenocarcinoma, compared with image assessment based on tissue density measurements (HU), and can lead to more accurate diagnosis. |
| Delrue et al. 2011 [20] | 54 | Pancreatic adenocarcinoma (n = 19), acute and chronic pancreatitis (n = 3 + 6), neuroendocrine tumors (n = 2), (pseudo)cystic lesions (n = 3), normal pancreas in healthy volunteers (n = 21) | 128 Dual-source CT | 50 mL | 100 kV, 145 mAs | Maximum slope (single-compartment) | To evaluate whether perfusion parameters can distinguish general pathologies of the pancreas and possibly aid in early diagnosis. | Histology | Pancreatic adenocarcinoma: Significantly lower BF and BV in the center of the tumor than in normal pancreatic tissue in healthy volunteers (BF and BV: p < 0.01). Neuroendocrine tumors: Significantly higher values for BF and BV in tumor tissue compared with normal pancreatic tissue in healthy volunteers (p < 0.01). Acute and chronic pancreatitis: Significantly lower BF and BV than in normal pancreatic tissue in healthy volunteers (p < 0.01) Healthy volunteers: No significant differences were found in BF, BV, and PS between head, body, and tail of the pancreas. | Significant decreases in perfusion values in both adenocarcinomas and acute and chronic pancreatitis, and the opposite applies to values in neuroendocrine tumors, which were significantly increased, compared to the control group of healthy volunteers. Different perfusion values can be used as an additional parameter to differentiate pancreatic pathologies. |
| D’Onofrio et al. 2012 [21] | 32 | Pancreatic adenocarcinoma. Pathological analysis; low grade (n = 12) and high grade (n = 20). |
64 | 50 mL | 120 kV, 150 mAs | Maximum slope (single-compartment) | To describe DCE-CT features and to assess whether these features correlate with the tumor grading. | Histology | Significantly lower median values of BV and PEI in high grade neoplasms compared with low grade neoplasms (BV: p ≤ 0.004 and PEI: p ≤ 0.012). | DCE-CT can predict tumor grade of pancreatic adenocarcinoma. |
| Kandel et al. 2009 [22] | 30 | Pancreatic adenocarcinoma | 320 | 60 mL | 100 kV, 22.5 mAs | Maximum slope (single-compartment) | To evaluate a whole-organ DCE-CT protocol and to analyze perfusion differences between tumor tissue and normal pancreatic tissue. | Histology | Significantly lower BF in tumor tissue compared with pancreatic tissue outside of tumor (p ≤ 0.01). | DCE-CT carries the potential to improve detection of pancreatic cancers due to the perfusion differences. |
| Klauss et al. 2012 [23] | 25 | Pancreatic adenocarcinoma | 64 Dual-source | 80 mL | 80 kV and 270 mAs 140 kV and 50 mAs | Patlak model (two-compartment) | To evaluate the feasibility of DCE-CT for assessing differences in perfusion values of tumor tissue and normal pancreatic tissue. | Histology | Significantly lower BF, BV, and PS in tumor tissue than in pancreatic tissue outside of tumor (p < 0.0001). Significantly higher BF in the head of the pancreas than in the tail, measured in pancreatic tissue outside of tumor (p = 0.007). | DCE-CT using the Patlak analysis is feasible. Even isodense tumors could be delineated in the color-coded parameter maps. |
| Lu et al. 2011 [24] | 112 | Pancreatic adenocarcinoma (n = 64), mass-forming chronic pancreatitis (n = 15). Normal pancreas in healthy volunteers (n = 33) | 64 | 50 mL | 80 kV, 50 mAs | Maximum slope (single-compartment) | To investigate characteristics of pancreatic cancer, mass-forming chronic pancreatitis, and normal pancreas with DCE-CT. | Histology and AJCC 2002 classification system * |
Corrected p values < 0.016 were considered significant in this study. Pancreatic adenocarcinoma: Significantly lower BF and BV in tumor tissue compared with normal pancreatic tissue in healthy volunteers (p < 0.016). Significantly higher PS in pancreatic tissue outside of tumor than in normal pancreas in healthy volunteers (p < 0.016). Mass-forming chronic pancreatitis: Significantly lower BF and BV in mass-forming chronic pancreatitis than in normal pancreatic tissue in healthy volunteers (p < 0.016). Comparison –Pancreatic adenocarcinoma and mass-forming chronic pancreatitis: Significantly lower BF, BV, and PS values in pancreatic adenocarcinoma than in mass-forming chronic pancreatitis (p < .016). Healthy volunteers: No significant difference between the head, body, and tail of the pancreas. |
DCE-CT is feasible in providing quantitative hemodynamic information of pancreatic adenocarcinoma and mass-forming chronic pancreatitis. |
| Nishikawa et al. 2014 [25] | 17 | Pancreatic adenocarcinoma | 64 | 40 mL | 80 kV, 20 mAs | Maximum slope (single-compartment) | To investigate the relationship between patient prognosis and perfusion in tumor tissue and peritumoral tissue. | Histology, TNM * and Japanese classification (prognosis) |
Peritumoral tissue: Significant correlation between AUC peritumoral tissue (AUC of the Time Density Curve) or BF peritumoral tissue and survival days from the date on which perfusion CT was performed (AUC: p = 0.04, BF: 0.0005). Higher AUC peritumoral tissue and BF peritumoral tissue values were associated with shorter survival days. Tumor tissue: No significant correlation between BF and AUC in tumor tissue and survival days. |
Patient prognosis may be related to perfusion in peritumoral tissue observed with DCE-CT. |
| Xu et al. 2009 [26] | 76 | Pancreatic adenocarcinoma (n = 40). Normal pancreatic tissue in patients with non-pancreatic disease (n = 36) | 64 | 50 mL | 120 kV, 150 mA (rotation time: N/A) | Deconvolution method | To explore the perfusion characteristics of pancreatic adenocarcinoma and normal pancreatic tissue in patients with non-pancreatic disease. | Histology | Pancreatic adenocarcinoma: Significant difference in BF, BV, and PS between tumor tissue, tumor rim, and peripheral pancreatic tissue in pancreatic adenocarcinoma, with gradually increased values from tumor tissue to tumor rim and peripheral pancreatic tissue (p < 0.02). Normal pancreas with non-pancreatic disease: No significant difference in BF, BV, or PS, between the head, neck, body, and tail. Comparison between patients with pancreatic adenocarcinoma and patients with non-pancreatic disease: Significantly lower values of BF, BV, tumor tissue, and tumor rim compared with normal pancreatic tissue in patients with non-pancreatic disease (p < 0.05). Significantly lower PS in tumor tissue compared with normal pancreatic tissue in patients with non-pancreatic disease (p < 0.05). Significantly higher PS in tumor rim and in peripheral pancreatic tissue of pancreatic adenocarcinoma compared with normal pancreatic tissue in patients with non-pancreatic disease (p < 0.05). | DCE-CT can differentiate pathological changes from normal tissue. Therefore, DCE-CT should be considered a potential modality to increase the accuracy of CT diagnosis for pancreatic adenocarcinoma. |
Abbreviations: MVD (Microvessel Density); BF (Blood Flow); BV (Blood Volume); † WHO (World Health Organization) 2000 criteria-WHO 1: Well-differentiated endocrine tumors of benign behavior. WHO 2: Well-differentiated endocrine tumors of uncertain behavior. WHO 3: well-differentiated endocrine carcinomas. WHO 4: poorly differentiated endocrine carcinomas; PS (Permeability Surface); HU (Hounsfield Units); PEI (Peak Enhancement Intensity); * AJCC (American Joint Committee on Cancer); TNM (Tumor, Nodes, Metastasis); AUC (Area under Curve); N/A (Not Available).