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Small (≤20 mm) Pancreatic Adenocarcinomas: Analysis of Enhancement Patterns and Secondary Signs with Multiphasic Multidetector CT
Abstract
PURPOSE: To evaluate the enhancement patterns, prevalence of secondary signs, and histopathologic features of 20-mm-diameter or smaller pancreatic cancers seen on multiphasic multidetector computed tomographic (CT) images. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board; the requirement for informed consent was waived. From January 2002 through September 2009, the authors reviewed the clinical and imaging data of 130 consecutive patients (76 men, 54 women; mean age, 64.1 years; age range, 28-82 years) who had surgically proven 30-mm-diameter or smaller pancreatic cancers and underwent preoperative multidetector CT and 33 consecutive patients (17 men, 16 women; mean age, 65.1 years; age range, 48-84 years) who had histopathologically proven pancreatic cancer and underwent incidental multidetector CT before the diagnosis was rendered. Only pancreatic phase CT was performed in two patients, and only hepatic venous phase CT was performed in nine patients. Two radiologists in consensus classified the tumor attenuation as hyper-, iso-, or hypoattenuation during the pancreatic and hepatic venous phases. Accompanying secondary signs, temporal changes in tumor attenuation, and histopathologic findings also were analyzed. The Fisher exact test, χ(2) test, generalized estimating equation, and Student t test were used to compare the variables. RESULTS: Seventy tumors were 20 mm or smaller, and 93 were 21-30 mm. Isoattenuating pancreatic cancers were more commonly observed among the 20-mm or smaller tumors (16 of 59, 27%) than among the 21-30-mm tumors (12 of 93, 13%) (P = .033). They were also more common among well-differentiated tumors (seven of 12, 58%) than among moderately differentiated (20 of 124, 16%) and poorly differentiated (one of 10, 10%) tumors (P = .001). The prevalence of secondary signs differed significantly according to tumor size (53 [76%] of 70 ≤20-mm tumors vs 92 [99%] of 93 21-30-mm tumors) (P < .001). The prevalence of secondary signs was high among isoattenuating pancreatic cancers (14 [88%] of 16 ≤20-mm tumors vs all 12 [100%] 21-30-mm tumors). Most of the isoattenuating tumors seen at prediagnostic CT were hypoattenuating after 6 months (100% [four of four] during pancreatic phase, 71% [five of seven] during hepatic venous phase). CONCLUSION: The prevalence of isoattenuating pancreatic cancers differed significantly according to tumor size and cellular differentiation. Most small isoattenuating pancreatic cancers showed secondary signs. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101133/-/DC1.
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“Suspected lesions of pancreatic cancer have been found in 40–85% of cases where CT was conducted before a pancreatic cancer diagnosis (11,16-18).”
From Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer (2023) · cites this paper as [18]
In the citing paper
“Moreover, Yoon et al. (18) reported that detectable tumors were found in 24 (72.3%) of 33 patients with prediagnostic CT; the tumor size was <20 mm in 21 patients and 21–30 mm in three patients.”
From Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer (2023) · cites this paper as [18]
In the citing paper
“Based on a study by Yoon et al. (18), 99% of pancreatic cancers with a size of 21–30 mm and 76% of pancreatic cancers with a size of ≤20 mm showed pancreatic duct dilatation and interruption on CT.”
From Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer (2023) · cites this paper as [18]
In the citing paper
“Typical CT findings of pancreatic cancer are hypoattenuating tumor in the arterial and portal venous phases with secondary findings such as pancreatic duct dilatation, pancreatic duct break, common bile duct dilatation, and pancreatic atrophy (8,18).”
From Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer (2023) · cites this paper as [18]
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Self-citation
Metadata
- Authors
- Yoon, S. H., Lee, J. M., Cho, J. Y., Lee, K. B., Kim, J. E., Moon, S. K., Kim, S. J., Baek, J. H., Kim, S. H., Kim, S. H., Lee, J. Y., Han, J. K., & Choi, B. I.
- Affiliations
- Seoul National University (KR)
- UNSW Sydney (AU)
- ORCID
- Venue
- Radiology
- Published
- 2011-05
- Volume
- 259
- Issue
- 2
- Pages
- 442-452
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- OpenAlex
- W2125198438
- Cited by
- 257
- References
- 34
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 18 · 2023: 24 · 2022: 29 · 2021: 26 · 2020: 27 · 2019: 9 · 2018: 13 · 2017: 15 · 2016: 11 · 2015: 19 · 2014: 11 · 2013: 16 · 2012: 9
- FWCI
- 6.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Radiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Keywords
- pancreatic ductal adenocarcinoma, small pancreatic tumors, tumor enhancement pattern, tumor differentiation, tumor size, tumor attenuation, incidental CT finding, histopathological correlation, preoperative imaging features, tumor vascularity, tumor necrosis
- MeSH terms
- Adenocarcinoma, Adult, Aged, Aged, 80 and over, Contrast Media, Female, Humans, Iohexol, Male, Middle Aged, Pancreatic Neoplasms, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Tomography, X-Ray Computed, Chi-Square Distribution
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