Pancreatic fibrosis assessment and association with pancreatic cancer: comparison with the extracellular volume fraction

• Published in: Clinical radiology
• Main Authors: Fukui, H., Onishi, H., Ota, T., Nakamoto, A., Tsuboyama, T., Enchi, Y., Yamada, D., Takeda, Y., Kobayashi, S., Fukuda, Y., Eguchi, H., Matsui, T., Tatsumi, M., Tomiyama, N.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 12.08.2024
• Subjects: SSIM; IWR; ROC; ICC; HPFF; RMSE; AIC; fECV; ROI; AUC
• ISSN: 0009-9260; 1365-229X; 1365-229X
• DOI: 10.1016/j.crad.2024.08.007

To compare the iodine washout rate (IWR) from multiphasic contrast-enhanced computed tomography (CT) with the extracellular volume fraction (fECV) for assessing pancreatic fibrosis and its association with pancreatic cancer. The study included 51 individuals (33 men; median age: 69 years; 21 with pancreatic cancer, 30 with other diseases) who underwent multiphasic contrast-enhanced CT and histological evaluation for fibrotic changes in pancreas. The histological pancreatic fibrosis fraction (HPFF) was assessed on Azan-stained sections. Pancreatic parenchymal enhancement values were measured to calculate IWR and fECV. Statistical methods, such as Spearman's rho and Mann–Whitney U-test, were used. Linear regression models using IWR and fECV were constructed to predict HPFF, with the performance expressed as root mean squared error (RMSE) and Akaike information criterion (AIC). HPFF correlated with all CT parameters at the estimated transection line, strongest for IWRPPP−EP (r=−0.69, P<0.01). HPFF and fECV values were higher in the pancreatic cancer group than in controls (30% vs. 12.5%, P<0.01; 40.3% vs. 33.0%, P<0.01), whereas IWR values were lower (IWRPPP-EP: 43.3% vs. 55.0%, P<0.01; IWRPVP-EP: 25.0% vs. 33.5%, P<0.01). Linear regression models combining IWRPPP−EP + fECV and IWRPVP−EP + fECV were superior for predicting HPFF, with lower RMSE (9.23–9.35) and AIC (379.38–380.72) values than models with IWR or fECV alone. IWRPPP−EP, IWRPVP−EP, and fECV were reliable biomarkers for noninvasively assessing pancreatic fibrosis and were associated with pancreatic cancer risk. Linear regression combining these variables showed enhanced predictive accuracy for pancreatic fibrosis. •Iodine washout rate and extracellular volume fraction correlated with fibrosis.•Iodine washout rate and extracellular volume fraction accurately predicted fibrosis.•Pancreatic cancer: higher extracellular volume fraction, lower iodine washout rate.