Pancreatic cancer and chronic pancreatitis differential diagnosis by multidetector computed tomography results postprocessing: a novel approach presentation

Abstract

Background/Aim: Differential diagnosis of pancreatic cancer (PC) and chronic pancreatitis (CP) remains challenging question in radiology and pancreatology. A potential key to resolve this problem is postprocessing of multidetector computed tomography (CT) results. Our aim was to assess the diagnostic potential of contrast enhancement dynamics analysis using CT in the differential diagnosis of PC and CP.
Methods: This study analyzed contrast-enhanced abdominal CT images from 135 patients with CP and suspected PC. The cohort comprised 77 (57%) male and 58 (43%) female patients, with a mean age of 53.8±13.1 years, who underwent examination and treatment between January 2018 and July 2025. All diagnoses were morphologically verified, confirming 49 (36.3%) cases of PC and 86 (63.7%) of CP; with 5 year follow up for CP cases to exclude false results. The median attenuation gradient (Mgrad) between the tumor-suspicious area and intact pancreatic tissue was calculated from the CT data. Diagnostic performance was assessed using ROC-analysis with calculation of the area under the curve (AUC). The confidence interval (CI) was 95%, and differences were considered statistically significant at p < 0.05. Correlation analysis was performed using Spearman’s correlation coefficient (rho).
Results: The mean Mgrad value was statistically significantly higher in the PC group (26.6±8.2 HU) than in the CP group (13.9±5.1 HU), p=0.0001. Using an empirically derived threshold of Mgrad = 20 HU, the sensitivity of Mgrad value in differentiating PC from CP was 88.2% and specificity was 95.2%, with an AUC of 0.94. The sensitivity of standard contrast-enhanced CT without postprocessing was 69.5%, specificity was 92.1%, and AUC was 0.83. Based on ROC analysis, a threshold value of Mgrad = 18.6 HU was calculated, yielding a sensitivity of 93.9% and specificity of 93%. A strong positive correlation was found between Mgrad value and the presence of PC (rho=0.73; p=0.0001).
Conclusion: The Mgrad value aids in the differential diagnosis of PC and CP by quantifying differences in contrast enhancement dynamics between tumor and pancreatic tissue altered by CP.