Feasibility of Dynamic Volume Perfusion CT for Treatment Response Monitoring in Pancreatic Adenocarcinoma.

RATIONALE AND

OBJECTIVES

Perfusion CT has shown predictive value for tumor response, grade, and recurrence in pancreatic adenocarcinoma (PAC). However, its utility for real-time dynamic monitoring during chemotherapy has not been systematically evaluated. This study aimed to evaluate the feasibility of dynamic volume perfusion CT (dVPCT) for treatment response monitoring in patients with PAC.

MATERIALS AND

METHODS

This retrospective study included consecutive patients with pathologically confirmed PAC who underwent systemic chemotherapy and dVPCT between December 2024 and May 2026. Treatment response was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. For cross-sectional analysis, blood flow (BF), blood volume (BV), mean transit time (MTT), and flow extraction product (FEP) measured at the first response-evaluable dVPCT examination were compared between the disease-control group (partial response [PR] or stable disease [SD]) and the progressive-disease (PD) group. For longitudinal analysis, patients with serial dVPCT examinations were included, and interval changes in perfusion parameters between consecutive examinations were calculated. Linear mixed-effects models were used to evaluate longitudinal associations.

RESULTS

A total of 87 patients underwent 141 dVPCT examinations and were included in the study. Among them, 36 patients contributed 54 evaluable scan intervals for longitudinal analysis. In the cross-sectional analysis, BF was significantly higher in the PR/SD group than in the PD group (38.48 vs 26.98 mL/100mL/min, P = .013). In the longitudinal analysis, increases in BF (Estimate = 12.14, P = .011) were significantly associated with disease control after adjustment.

CONCLUSION

Higher BF and longitudinal increases in BF were associated with better disease control during systemic chemotherapy. dVPCT can provide functional information complementary to RECIST 1.1-based response assessment at a radiation dose comparable to routine multiphase contrast-enhanced CT, supporting its potential role in treatment response monitoring in PAC.