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Rofo 2014; 186(12): 1082-1093
DOI: 10.1055/s-0034-1384876
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas

Die Rolle des Volumenperfusions-CT in der Diagnostik von Pankreaspathologika
G. Grözinger
,
A. Grözinger
,
M. Horger
Further Information

Publication History

06 February 2014

15 June 2014

Publication Date:
14 August 2014 (online)

Also available at
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Abstract

The review discusses the potential role of volume perfusion CT (VPCT) in the diagnosis and follow-up of different pathologies of the pancreas. VPCT enables a differentiation of different pancreatic tumors like adenocarcinoma or neuroendocrine tumors based on functional parameters like blood flow, blood volume and permeability. Furthermore, the article discusses the potential indications for VPCT imaging of inflammatory diseases of the pancreas such as acute or chronic pancreatitis and autoimmune pancreatitis.

Key Points:

• VPCT may help to diagnose even small pancreatic tumors based on functional parameters

• Functional perfusion parameters can help to characterize pancreatic neoplasms

• In acute pancreatitis VPCT can evaluate the perfusion status of the organ

Citation Format:

• Grözinger G., Grözinger A., Horger M. The Role of Volume Perfusion CT in the Diagnosis of Pathologies of the Pancreas. Fortschr Röntgenstr 2014; 186: 1082 – 1093

Zusammenfassung

Der Übersichtsartikel behandelt die mögliche Rolle des Volumenperfusions-CT bei der Diagnostik und der Nachsorge von verschiedenen Pathologien des Pankreas. Das VPCT ermöglicht dabei eine Unterscheidung von verschiedenen Pankreastumoren wie dem Adenokarzinom oder neuroendokrinen Tumoren aufgrund von funktionellen Parametern wie Blutfluss, Blutvolumen und Permeabilität. Des Weiteren diskutiert der Artikel mögliche Indikationen für die VPCT-Bildgebung bei entzündlichen Erkrankungen des Pankreas wie akute oder chronische Pankreatitis und autoimmune Pankreatitis.

Key words

abdomen - pancreas - CT-quantitative

Deutscher Artikel/German Article

 

  • References

  • 1 Fidler JL, Fletcher JG, Reading CC et al. Preoperative detection of pancreatic insulinomas on multiphasic helical CT. Am J Roentgenol. American journal of roentgenology 2003; 181: 775-780 DOI: 10.2214/ajr.181.3.1810775. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 2 Boland GW, O'Malley ME, Saez M et al. Pancreatic-phase versus portal vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma. Am J Roentgenol. American journal of roentgenology 1999; 172: 605-608 DOI: 10.2214/ajr.172.3.10063844. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 3 Imbriaco M, Megibow AJ, Ragozzino A et al. Value of the single-phase technique in MDCT assessment of pancreatic tumors. Am J Roentgenol. American journal of roentgenology 2005; 184: 1111-1117 DOI: 10.2214/ajr.184.4.01841111. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 4 Tatsumoto S, Kodama Y, Sakurai Y et al. Pancreatic neuroendocrine neoplasm: correlation between computed tomography enhancement patterns and prognostic factors of surgical and endoscopic ultrasound-guided fine-needle aspiration biopsy specimens. Abdominal imaging 2013; 38: 358-366 DOI: 10.1007/s00261-012-9953-8. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 5 Stafford-Johnson DB, Francis IR, Eckhauser FE et al. Dual-phase helical CT of nonfunctioning islet cell tumors. Journal of computer assisted tomography 1998; 22: 335-339
    CrossrefPubMedGoogle Scholar
  • 6 Graf O, Boland GW, Warshaw AL et al. Arterial versus portal venous helical CT for revealing pancreatic adenocarcinoma: conspicuity of tumor and critical vascular anatomy. Am J Roentgenol. American journal of roentgenology 1997; 169: 119-123 DOI: 10.2214/ajr.169.1.9207510. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 7 Delrue L, Blanckaert P, Mertens D et al. Assessment of tumor vascularization in pancreatic adenocarcinoma using 128-slice perfusion computed tomography imaging. Journal of computer assisted tomography 2011; 35: 434-438 DOI: 10.1097/RCT.0b013e318223f0c5. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 8 d'Assignies G, Couvelard A, Bahrami S et al. Pancreatic endocrine tumors: tumor blood flow assessed with perfusion CT reflects angiogenesis and correlates with prognostic factors. Radiology 2009; 250: 407-416 DOI: 10.1148/radiol.2501080291. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 9 Park MS, Klotz E, Kim MJ et al. Perfusion CT: noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy. Radiology 2009; 250: 110-117 DOI: 10.1148/radiol.2493080226. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 10 Sharma J, Duque M, Saif MW. Emerging therapies and latest development in the treatment of unresectable pancreatic neuroendocrine tumors: an update for clinicians. Therapeutic advances in gastroenterology 2013; 6: 474-490 DOI: 10.1177/1756283X13498808. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 11 Walker EJ, Ko AH. Beyond first-line chemotherapy for advanced pancreatic cancer: An expanding array of therapeutic options?. World journal of gastroenterology: WJG 2014; 20: 2224-36 doi: 10.3748/wjg.v20.i9.2224 [published Online First: Epub Date]|
    CrossrefPubMedGoogle Scholar
  • 12 Nakao A, Kasuya H, Sahin TT et al. A phase I dose-escalation clinical trial of intraoperative direct intratumoral injection of HF10 oncolytic virus in non-resectable patients with advanced pancreatic cancer. Cancer gene therapy 2011; 18: 167-75 doi: 10.1038/cgt.2010.65 [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 13 Petralia G, Preda L, D'Andrea G et al. CT perfusion in solid-body tumours. Part I: Technical issues. La Radiologia medica 2010; 115: 843-857 DOI: 10.1007/s11547-010-0519-y. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 14 Delrue L, Blanckaert P, Mertens D et al. Variability of CT contrast enhancement in the pancreas: a cause for concern?. Pancreatology: official journal of the International Association of Pancreatology 2011; 11: 588-594 DOI: 10.1159/000334547. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 15 Miles KA. Perfusion CT for the assessment of tumour vascularity: which protocol?. The British journal of radiology 2003; Spec No 1 76: S36-S42
    CrossrefPubMedGoogle Scholar
  • 16 Miles KA, Charnsangavej C, Lee FT et al. Application of CT in the investigation of angiogenesis in oncology. Academic radiology 2000; 7: 840-850
    CrossrefPubMedGoogle Scholar
  • 17 Ketelsen D, Horger M, Buchgeister M et al. Estimation of radiation exposure of 128-slice 4D-perfusion CT for the assessment of tumor vascularity. Korean journal of radiology: official journal of the Korean Radiological Society 2010; 11: 547-552 DOI: 10.3348/kjr.2010.11.5.547. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 18 Xie Q, Wu J, Tang Y et al. Whole-Organ CT Perfusion of the Pancreas: Impact of Iterative Reconstruction on Image Quality, Perfusion Parameters and Radiation Dose in 256-Slice CT-Preliminary Findings. PloS one 2013; 8: e80468 DOI: 10.1371/journal.pone.0080468. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 19 Christe A, Heverhagen J, Ozdoba C et al. CT dose and image quality in the last three scanner generations. World journal of radiology 2013; 5: 421-429 [published Online First: Epub Date] DOI: 10.4329/wjr.v5.i11.421.
    CrossrefPubMedGoogle Scholar
  • 20 Li HO, Sun C, Xu ZD et al. Low-dose whole organ CT perfusion of the pancreas: preliminary study. Abdominal imaging 2014; 39: 40-47 DOI: 10.1007/s00261-013-0045-1. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 21 Klauss M, Stiller W, Fritz F et al. Computed tomography perfusion analysis of pancreatic carcinoma. Journal of computer assisted tomography 2012; 36: 237-242 DOI: 10.1097/RCT.0b013e31824a099e. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 22 Kuehn R, Lelkes PI, Bloechle C et al. Angiogenesis, angiogenic growth factors, and cell adhesion molecules are upregulated in chronic pancreatic diseases: angiogenesis in chronic pancreatitis and in pancreatic cancer. Pancreas 1999; 18: 96-103
    CrossrefPubMedGoogle Scholar
  • 23 D'Onofrio M, Gallotti A, Mantovani W et al. Perfusion CT can predict tumoral grading of pancreatic adenocarcinoma. European journal of radiology 2013; 82: 227-233 DOI: 10.1016/j.ejrad.2012.09.023. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 24 Delrue L, Blanckaert P, Mertens D et al. Tissue perfusion in pathologies of the pancreas: assessment using 128-slice computed tomography. Abdominal imaging 2012; 37: 595-601 DOI: 10.1007/s00261-011-9783-0. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 25 Buerke B, Heindel W, Wessling J. Differential diagnosis and radiological management of cystic pancreatic lesions. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2010; 182: 852-860 DOI: 10.1055/s-0029-1245502. [published Online First: Epub Date]
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Itoh S, Ishiguchi T, Ishigaki T et al. Mucin-producing pancreatic tumor: CT findings and histopathologic correlation. Radiology 1992; 183: 81-86 DOI: 10.1148/radiology.183.1.1312735. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 27 Kim SY, Lee JM, Kim SH et al. Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. Am J Roentgenol. American journal of roentgenology 2006; 187: 1192-1198 DOI: 10.2214/Am J Roentgenol.05.0337. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 28 Nakai Y, Isayama H, Itoi T et al. Role of endoscopic ultrasonography in pancreatic cystic neoplasms: Where do we stand and where will we go?. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society 2014; 26: 135-143 DOI: 10.1111/den.12202. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 29 Kloppel G, Kosmahl M. Cystic lesions and neoplasms of the pancreas. The features are becoming clearer. Pancreatology: official journal of the International Association of Pancreatology 2001; 1: 648-655 DOI: 10.1159/000055876. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 30 Silas AM, Morrin MM, Raptopoulos V et al. Intraductal papillary mucinous tumors of the pancreas. Am J Roentgenol. American journal of roentgenology 2001; 176: 179-185 DOI: 10.2214/ajr.176.1.1760179. [published Online First: Epub Date]|.
    PubMedGoogle Scholar
  • 31 Grutzmann R, Post S, Saeger HD et al. Intraductal papillary mucinous neoplasia (IPMN) of the pancreas: its diagnosis, treatment, and prognosis. Deutsches Arzteblatt international 2011; 108: 788-794 DOI: 10.3238/arztebl.2011.0788. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 32 Liu TC, Hamilton N, Hawkins W et al. Comparison of WHO Classifications (2004, 2010), the Hochwald grading system, and AJCC and ENETS staging systems in predicting prognosis in locoregional well-differentiated pancreatic neuroendocrine tumors. The American journal of surgical pathology 2013; 37: 853-859 DOI: 10.1097/PAS.0b013e31827fcc18. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 33 Anlauf M. Neuroendocrine neoplasms of the gastroenteropancreatic system: pathology and classification. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2011; 43: 825-831 DOI: 10.1055/s-0031-1291307. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 34 Gallotti A, Johnston RP, Bonaffini PA et al. Incidental neuroendocrine tumors of the pancreas: MDCT findings and features of malignancy. Am J Roentgenol. American journal of roentgenology 2013; 200: 355-362 DOI: 10.2214/Am J Roentgenol.11.8037. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 35 Lewis RB, Lattin Jr. GE, Paal E. Pancreatic endocrine tumors: radiologic-clinicopathologic correlation. Radiographics: a review publication of the Radiological Society of North America, Inc 2010; 30: 1445-1464 DOI: 10.1148/rg.306105523. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 36 Ng CS, Charnsangavej C, Wei W et al. Perfusion CT findings in patients with metastatic carcinoid tumors undergoing bevacizumab and interferon therapy. Am J Roentgenol. American journal of roentgenology 2011; 196: 569-576 DOI: 10.2214/Am J Roentgenol.10.4455. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 37 Raman SP, Hruban RH, Cameron JL et al. Pancreatic imaging mimics: part 2, pancreatic neuroendocrine tumors and their mimics. Am J Roentgenol. American journal of roentgenology 2012; 199: 309-318 DOI: 10.2214/Am J Roentgenol.12.8627. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 38 Coakley FV, Hanley-Knutson K, Mongan J et al. Pancreatic imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma. Am J Roentgenol. American journal of roentgenology 2012; 199: 301-308 DOI: 10.2214/Am J Roentgenol.11.7907. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 39 Spira D, Adam P, Linder C et al. Perfusion and flow extraction product as potential discriminators in untreated follicular and diffuse large B cell lymphomas using volume perfusion CT with attempt at histopathologic explanation. Am J Roentgenol. American journal of roentgenology 2012; 198: 1239-1246 DOI: 10.2214/Am J Roentgenol.11.7858. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 40 Tsuji Y, Hamaguchi K, Watanabe Y et al. Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis. Journal of gastroenterology 2010; 45: 1155-1162 DOI: 10.1007/s00535-010-0267-8. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 41 Zamboni GA, Bernardin L, Pozzi MucelliR. Dynamic MDCT of the pancreas: is time-density curve morphology useful for the differential diagnosis of solid lesions?. A preliminary report. European journal of radiology 2012; 81: e381-e385 DOI: 10.1016/j.ejrad.2011.11.055. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 42 Sandrasegaran K, Nutakki K, Tahir B et al. Use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. Am J Roentgenol. American journal of roentgenology 2013; 201: 1002-1008 DOI: 10.2214/Am J Roentgenol.12.10170. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 43 Blasbalg R, Baroni RH, Costa DN et al. MRI features of groove pancreatitis. Am J Roentgenol. American journal of roentgenology 2007; 189: 73-80 DOI: 10.2214/Am J Roentgenol.06.1244. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 44 Shin JU, Lee JK, Kim KM et al. The differentiation of autoimmune pancreatitis and pancreatic cancer using imaging findings. Hepato-gastroenterology 2013; 60: 1174-1181 DOI: 10.5754/hge11946. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 45 Takahashi N, Fletcher JG, Fidler JL et al. Dual-phase CT of autoimmune pancreatitis: a multireader study. Am J Roentgenol. American journal of roentgenology 2008; 190: 280-286 DOI: 10.2214/Am J Roentgenol.07.2309. [published Online First: Epub Date]
    PubMedGoogle Scholar
  • 46 Motosugi U, Ichikawa T, Sou H et al. Multi-organ perfusion CT in the abdomen using a 320-detector row CT scanner: preliminary results of perfusion changes in the liver, spleen, and pancreas of cirrhotic patients. European journal of radiology 2012; 81: 2533-2537 DOI: 10.1016/j.ejrad.2011.11.054. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 47 Tsushima Y, Miyazaki M, Taketomi-Takahashi A et al. Feasibility of measuring human pancreatic perfusion in vivo using imaging techniques. Pancreas 2011; 40: 747-752 DOI: 10.1097/MPA.0b013e318215ac22. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 48 Xu J, Liang Z, Hao S et al. Pancreatic adenocarcinoma: dynamic 64-slice helical CT with perfusion imaging. Abdominal imaging 2009; 34: 759-766 DOI: 10.1007/s00261-009-9564-1. [published Online First: Epub Date]
    CrossrefPubMedGoogle Scholar
  • 49 Bize PE, Platon A, Becker CD et al. Perfusion measurement in acute pancreatitis using dynamic perfusion MDCT. Am J Roentgenol. American journal of roentgenology 2006; 186: 114-118 DOI: 10.2214/Am J Roentgenol.04.1416. [published Online First: Epub Date]
    PubMedGoogle Scholar