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Published online before print November 4, 2008, 10.1148/radiol.2493080226

(Radiology 2009;250:110.)

A more recent version of this article appeared on January 1, 2009
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© RSNA, 2008

Gastrointestinal Imaging

Perfusion CT: Noninvasive Surrogate Marker for Stratification of Pancreatic Cancer Response to Concurrent Chemo- and Radiation Therapy1

Mi-Suk Park, MD, Ernst Klotz, Dipl Phys, Myeong-Jin Kim, MD, Si Young Song, MD, Seung Woo Park, MD, Seung-Whan Cha, MD, Joon Soek Lim, MD, Jinsil Seong, MD, Jae Bok Chung, MD, and Ki Whang Kim, MD

1 From the Departments of Diagnostic Radiology (M.S.P., M.J.K., S.W.C., J.S.L., K.W.K.), Internal Medicine (S.Y.S., S.W.P., J.B.C.), and Radiation Oncology (J.S.), Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, South Korea; Siemens Medical Solutions, Forchheim, Germany (E.K.); and Department of Diagnostic Radiology, Wonju Christian Hospital, Yonsei University College of Medicine, Wonju, South Korea (S.W.C.). Received February 1, 2008; revision requested April 9; revision received May 5; accepted June 19; final version accepted July 3. Supported by a faculty research grant of Yonsei University College of Medicine for 2006 (grant no. 6-2006-0079) and Nondirected Research Fund, Korea Research Foundation, 2007 (grant no. 7-2007-0232). Address correspondence to M.S.P. (e-mail: radpms{at}yuhs.ac).

Purpose: To prospectively determine whether perfusion computed tomography (CT) parameters, such as volume transfer constant (Ktrans) between blood plasma and extracellular extravascular space (EES) and blood volume calculated from dynamic CT data, can be used to predict response of pancreatic cancer to concurrent chemotherapy and radiation therapy (CCRT).

Materials and Methods: This prospective study was institutional review board approved, and written informed consent was obtained. Thirty patients with pancreatic cancer underwent perfusion CT with 64–detector row CT before gemcitabine-based CCRT. Two perfusion parameters (Ktrans and blood volume) measured before treatment were compared between patients who responded to treatment and those who did not, as determined with World Health Organization criteria from first and second posttherapeutic follow-up CT examinations, which were performed at 3- and 6-month follow-up. Statistical analysis was performed with the two-sample t test. A receiver operating characteristic curve was used to determine the best cutoff value of perfusion parameters for differentiation of responders from nonresponders.

Results: Twenty of 30 patients examined at 3-month follow-up responded to therapy. Their pretreatment Ktrans value was significantly higher than that of nonresponders (50.8 mL/100 mL/min ± 30.5 [standard deviation] vs 19.0 mL/100 mL/min ± 10.8, P = .001). The best cutoff value for differentiating between responders and nonresponders was 31.8 mL/100 mL/min, which yielded 75.0% sensitivity and 90.0% specificity. Ten of 18 patients examined at 6-month follow-up responded to therapy. Their pretreatment Ktrans value was significantly higher than that of nonresponders (58.6 mL/100 mL/min ± 43.2 vs 19.8 mL/100 mL/min ± 10.9, P = .002). Responders also had higher blood volume values, but this difference was not significant.

Conclusion: Tumors with a high pretreatment Ktrans value tended to respond better to CCRT than did tumors with a low pretreatment Ktrans value. Perfusion CT may be used to predict tumor response to CCRT in patients with pancreatic cancer. This might aid in development of a tailored approach to therapy in these patients.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2493080226/DC1

© RSNA, 2008