Dual-layer spectral detector CT: a non-invasive tool for simultaneously predicting Ki-67 proliferation status and p53 mutations in pancreatic ductal adenocarcinoma.

OBJECTIVES

To evaluate the value of dual-layer spectral detector CT (DLCT) for predicting Ki-67 proliferation status and p53 mutations in pancreatic ductal adenocarcinoma (PDAC).

MATERIALS & METHODS: This retrospective study included untreated patients with pathologically confirmed PDAC who underwent DLCT between June 2019 and September 2023. Independent relevant clinical-radiological features and quantitative parameters for predicting Ki-67 proliferation status and p53 mutations were identified using multivariate logistic regression analysis. The diagnostic performances of independent variables were evaluated using receiver operating characteristic curves.

RESULTS

We included 92 patients (60.19 ± 11.22 years old, 61 males). There were 40 patients with high Ki-67 expression (Ki-67 ≥ 25%) and 43 patients positive for p53 mutation. The radiologists showed substantial or near-perfect inter- and intra-observer agreement in evaluating quantitative parameters. Normalised iodine concentration in the arterial phase (nICa) was the only independent predictor of Ki-67 proliferation status (p < 0.001; adjusted odds ratio [OR], 2.33; 95% confidence interval [CI]: 1.46, 3.74; cut-off, 0.0910) and p53 mutations (p < 0.001; adjusted OR, 1.35; 95% CI: 1.07, 1.71; cut-off, 0.0905) according to the multivariate logistic analysis. nICa showed satisfactory performance when using the chosen rounded cut-off value of 0.090 (easily applicable in clinical practice) in predicting Ki-67 proliferation (area under the receiver operating characteristic curve [AUC], 0.812; sensitivity, 87.5%; specificity, 75.0%) and p53 mutations (AUC, 0.731; sensitivity, 76.7%; specificity, 69.4%).

CONCLUSION

The DLCT parameter nICa enables simultaneous and non-invasive prediction of both Ki-67 proliferation status and p53 mutations in PDAC with satisfactory diagnostic efficacy.