title: Perfusion CT - Can it resolve the pancreatic carcinoma versus mass forming chronic pancreatitis conundrum?
abstract: OBJECTIVE
  To evaluate the utility of perfusion CT (PCT) in differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis (MFCP).
  
  
  METHODS
  In this ethically approved study, PCT was performed in 122 patients with pancreatic masses of which 42 patients had pancreatic adenocarcinoma and 13 had MFCP on histopathology. Perfusion parameters studied included blood flow (BF), blood volume (BV), permeability surface area product (PS), time to peak (TTP), peak enhancement intensity (PEI) and mean transit time (MTT). Twenty five controls with no pancreatic pathology were also studied.
  
  
  RESULTS
  Amongst the perfusion parameters BF and BV were found to be the most reliable for differentiating between adenocarcinoma and mass forming pancreatitis. Although they were reduced in both pancreatic adenocarcinoma (BF- 16.6 ± 13.1 ml/100 ml/min and BV- 5 ± 3.5 ml/100 ml) and MFCP (BF- 30.4 ± 8.7 ml/100 ml/min and BV- 8.9 ± 3.1 ml/100 ml) as compared to normal controls (BF- 94.1 ± 24 ml/100 ml/min and BV- 36 ± 10.7 ml/100 ml) but the extent of reduction was greater in pancreatic adenocarcinoma than in MFCP. Based on ROC analysis cut off values of 19.1 ml/100 ml/min for BF and 5 ml/100 ml for BV yielded optimal sensitivity and specificity for differentiating pancreatic adenocarcinoma from MFCP.
  
  
  CONCLUSIONS
  PCT may serve as an additional paradigm for differentiating pancreatic adenocarcinoma from mass forming chronic pancreatitis and a useful tool for detecting masses which are isodense on conventional CT.
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Ajay Kumar
authors: AK
authors: Yadav
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India. Electronic address: raju152@yahoo.com.
authors: Raju
authors: R
authors: Sharma
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Devasenathipathy
authors: D
authors: Kandasamy
authors: Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Rajesh Kumar
authors: RK
authors: Pradhan
authors: Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Pramod Kumar
authors: PK
authors: Garg
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Ashu Seith
authors: AS
authors: Bhalla
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Shivanand
authors: S
authors: Gamanagatti
authors: Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Deep N
authors: DN
authors: Srivastava
authors: Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, 110029, New Delhi, India.
authors: Peush
authors: P
authors: Sahni
authors: Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors: Ashish Datt
authors: AD
authors: Upadhyay
mesh_terms: D000328:Adult; D000368:Aged; D001810:Blood Volume; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D055420:Perfusion Imaging / Q000379:methods*; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Adenocarcinoma; Chronic pancreatitis; Pancreas; Perfusion CT