European journal of radiology · 2026
Spectral CT-Based habitat imaging for the prediction of occult lymph node metastasis in resectable pancreatic ductal Adenocarcinoma: Pathological validation via collagen ratio.
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Chen Yi, Liu Wei, Xie Tiansong, Gao Meng, Sun Jing, Zhang Zehua, Chen Lei, Wang Yu, Xu Jin, Zhou Zhengrong
Аннотация
IMPORTANCE: Occult lymph node metastasis (LNM) remains challenging to detect preoperatively in resectable pancreatic ductal adenocarcinoma (PDAC), yet has significant implications for treatment and prognosis.
OBJECTIVE: To evaluate the predictive value of spectral CT-based habitat imaging and CT-diagnosed peripancreatic invasion for occult LNM in resectable PDAC, with pathological validation using collagen ratio.
METHODS: This retrospective study included 113 patients with resectable PDAC who underwent triple-phase spectral CT before surgery. Occult LNM was defined as pathologically confirmed nodal metastasis without radiologically suspicious lymph nodes; nodes with short-axis diameter ≥10 mm were excluded. Tumors were segmented into subregions based on pancreatic-to-venous phase iodine concentration ratio (PVICR), and subregional volume fractions were quantified. Correlations with collagen ratio were assessed via Spearman analysis. Patients were divided into a training cohort (n = 79; 30 with occult LNM) and a validation cohort (n = 34; 12 with occult LNM). A logistic regression model with backward stepwise selection was developed and evaluated by receiver operating characteristic analysis.
RESULTS: Four subregions were identified. Subregion 1, characterized by the lowest PVICR, showed a moderate negative correlation with collagen ratio (r = - 0.543, p < 0.001). The combined model incorporating the Subregion 1 fraction and CT-diagnosed peripancreatic invasion yielded areas under the curve of 0.836 (95% CI: 0.733-0.921) and 0.820 (95% CI: 0.661-0.955) in the training and validation cohorts, respectively.
CONCLUSIONS: Subregion 1 fraction and CT-diagnosed peripancreatic invasion enable accurate preoperative prediction of occult LNM in resectable PDAC.
OBJECTIVE: To evaluate the predictive value of spectral CT-based habitat imaging and CT-diagnosed peripancreatic invasion for occult LNM in resectable PDAC, with pathological validation using collagen ratio.
METHODS: This retrospective study included 113 patients with resectable PDAC who underwent triple-phase spectral CT before surgery. Occult LNM was defined as pathologically confirmed nodal metastasis without radiologically suspicious lymph nodes; nodes with short-axis diameter ≥10 mm were excluded. Tumors were segmented into subregions based on pancreatic-to-venous phase iodine concentration ratio (PVICR), and subregional volume fractions were quantified. Correlations with collagen ratio were assessed via Spearman analysis. Patients were divided into a training cohort (n = 79; 30 with occult LNM) and a validation cohort (n = 34; 12 with occult LNM). A logistic regression model with backward stepwise selection was developed and evaluated by receiver operating characteristic analysis.
RESULTS: Four subregions were identified. Subregion 1, characterized by the lowest PVICR, showed a moderate negative correlation with collagen ratio (r = - 0.543, p < 0.001). The combined model incorporating the Subregion 1 fraction and CT-diagnosed peripancreatic invasion yielded areas under the curve of 0.836 (95% CI: 0.733-0.921) and 0.820 (95% CI: 0.661-0.955) in the training and validation cohorts, respectively.
CONCLUSIONS: Subregion 1 fraction and CT-diagnosed peripancreatic invasion enable accurate preoperative prediction of occult LNM in resectable PDAC.