PURPOSE To assess the role of CT-texture analysis (CTTA) for differentiation of pancreatic ductal adenocarcinoma (PDAC) from pancreatic neuroendocrine neoplasm (PNEN) in the portal-venous phase as compared with visual assessment and tumor-to-pancreas attenuation ratios. METHODS 53 patients (66.1 ± 8.6y) with PDAC and 42 patients (65.5 ± 12.2y) with PNEN who underwent contrast-enhanced CT for primary staging were evaluated. Volumes of interests (VOIs) were set in the tumor tissue at the portal-venous phase excluding adjacent structures. Based on pyradiomics library, 92 textural features were extracted including 1st, 2nd, and higher order features, and then compared between PNEN and PDAC. The visual assessment classified tumors into hypo-, iso-, or hyperdense to pancreas parenchyma or into homogeneous/heterogeneous. Additionally, attenuation ratios between the tumors and the non-involved pancreas were calculated. RESULTS 8/92 (8.6%) highly significant (p < 0.005) discriminatory textural features between PDAC and PNEN were identified including the 1st order features "median," "total energy," "energy," "10th percentile," "90th percentile," "minimum," "maximum," and the 2nd order feature "Gray-Level co-occurrence Matrix (GLCM) Informational Measure of Correlation (Imc2)." In PNEN, the higher order feature "GLSZM Small Area High Gray-Level Emphasis" proved significantly higher in G1 compared to G2/3 tumors (p < 0.05). The tumor/parenchyma ratios as well as the visual assessment into hypo-/iso-/hyperdense or homogeneous/heterogeneous did not significantly differ between PDAC and PNEN. CONCLUSIONS Our data indicate that CTTA is a feasible tool for differentiation of PNEN from PDAC and also of G1 from G2/3 PNEN in the portal-venous phase. Visual assessment and tumor-to-parenchyma ratios were not useful for discrimination.

中文翻译：

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计算机断层扫描纹理分析在门静脉增强期鉴别胰腺导管腺癌与胰腺神经内分泌肿瘤中的互补作用。

目的 评估 CT 纹理分析 (CTTA) 在区分门静脉期胰腺导管腺癌 (PDAC) 和胰腺神经内分泌肿瘤 (PNEN) 中的作用，并与视觉评估和肿瘤与胰腺的衰减比进行比较。方法 对 53 名 PDAC 患者（66.1±8.6 岁）和 42 名 PNEN 患者（65.5±12.2 岁）接受对比增强 CT 进行初步分期的评估。感兴趣体积 (VOI) 在门静脉期的肿瘤组织中设置，不包括相邻结构。基于 pyradiomics 库，提取了 92 个纹理特征，包括一阶、二阶和高阶特征，然后在 PNEN 和 PDAC 之间进行比较。视觉评估将肿瘤分类为胰腺实质的低密度、等密度或高密度或同质/异质。此外，计算肿瘤和未受累胰腺之间的衰减比。结果 8/92 (8.6%) 高度显着 (p < 0.005) 识别出 PDAC 和 PNEN 之间的区分纹理特征，包括一阶特征“中位数”、“总能量”、“能量”、“第 10 个百分位数”、“第 90 个百分位数” 、“最小值”、“最大值”和二阶特征“灰度共现矩阵 (GLCM) 相关性信息度量 (Imc2)”。在 PNEN 中，与 G2/3 肿瘤相比，G1 中的高阶特征“GLSZM 小区域高灰度强调”被证明显着更高（p < 0.05）。PDAC 和 PNEN 之间的肿瘤/实质比率以及对低/异/高密度或均质/异质的视觉评估没有显着差异。结论 我们的数据表明，CTTA 是在门静脉期区分 PNEN 和 PDAC 以及 G1 和 G2/3 PNEN 的可行工具。视觉评估和肿瘤与实质的比率对区分没有用。