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Background/objectives <p>Accurate differentiation between pancreatic carcinoma in situ (CIS) and small invasive pancreatic ductal adenocarcinoma (PDAC) is critical for optimizing patient management. This study aimed to assess the diagnostic performance of restricted diffusion on DWI and FDG uptake on PET-CT in distinguishing T1a/T1b PDAC from CIS.</p> Methods <p>We retrospectively analyzed 37 patients (23 with CIS and 14 with T1a/T1b PDAC) who underwent preoperative CT, MRI, endoscopic ultrasonography (EUS), and <sup>18</sup>F-fluorodeoxyglucose (FDG) PET-CT. Imaging findings, including hypoechoic area around the main pancreatic duct, restricted diffusion on diffusion-weighted MRI (DWI-MRI), and FDG uptake on PET-CT, were compared between the groups. Logistic regression analyses were performed to identify predictors of T1a/T1b PDAC.</p> Results <p>Among the T1a/T1b PDAC group, FDG uptake was observed in 6 (42.9%), contrasting sharply with only 1 of 23 CIS patients (4.3%) (<i>p</i> = 0.007). Restricted diffusion on DWI was more frequent in T1a/T1b PDAC (50.0%) than in CIS (17.4%), but did not reach statistical significance (<i>p</i> = 0.063). FDG uptake on PET-CT demonstrated the highest specificity (95.7%) for detecting T1a/T1b PDAC, resulting in an overall diagnostic accuracy of 75.7%. DWI offered a specificity of 82.6% but only moderate sensitivity (50.0%). In multivariable analysis, FDG uptake on PET-CT emerged as the sole independent predictor of T1a/T1b PDAC (odds ratio, 13.1; 95% confidence interval, 1.29–134.0; <i>p</i> = 0.030).</p> Conclusions <p>FDG uptake on PET-CT might be helpful in differentiating T1a/T1b PDAC from CIS. A multimodal imaging approach incorporating these findings may support more individualized treatment planning; however, further validation in larger prospective studies is warranted.</p>

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Clinical and imaging differences between pancreatic carcinoma in situ and T1a/T1b pancreatic ductal adenocarcinoma

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Tatsunori Satoh,
  • Shinya Kawaguchi,
  • Eiji Nakatani,
  • Haruna Takahashi,
  • Shinya Endo,
  • Naofumi Shirane,
  • Hideyuki Kanemoto,
  • Kazuya Ohno

摘要

Background/objectives

Accurate differentiation between pancreatic carcinoma in situ (CIS) and small invasive pancreatic ductal adenocarcinoma (PDAC) is critical for optimizing patient management. This study aimed to assess the diagnostic performance of restricted diffusion on DWI and FDG uptake on PET-CT in distinguishing T1a/T1b PDAC from CIS.

Methods

We retrospectively analyzed 37 patients (23 with CIS and 14 with T1a/T1b PDAC) who underwent preoperative CT, MRI, endoscopic ultrasonography (EUS), and 18F-fluorodeoxyglucose (FDG) PET-CT. Imaging findings, including hypoechoic area around the main pancreatic duct, restricted diffusion on diffusion-weighted MRI (DWI-MRI), and FDG uptake on PET-CT, were compared between the groups. Logistic regression analyses were performed to identify predictors of T1a/T1b PDAC.

Results

Among the T1a/T1b PDAC group, FDG uptake was observed in 6 (42.9%), contrasting sharply with only 1 of 23 CIS patients (4.3%) (p = 0.007). Restricted diffusion on DWI was more frequent in T1a/T1b PDAC (50.0%) than in CIS (17.4%), but did not reach statistical significance (p = 0.063). FDG uptake on PET-CT demonstrated the highest specificity (95.7%) for detecting T1a/T1b PDAC, resulting in an overall diagnostic accuracy of 75.7%. DWI offered a specificity of 82.6% but only moderate sensitivity (50.0%). In multivariable analysis, FDG uptake on PET-CT emerged as the sole independent predictor of T1a/T1b PDAC (odds ratio, 13.1; 95% confidence interval, 1.29–134.0; p = 0.030).

Conclusions

FDG uptake on PET-CT might be helpful in differentiating T1a/T1b PDAC from CIS. A multimodal imaging approach incorporating these findings may support more individualized treatment planning; however, further validation in larger prospective studies is warranted.