Histological influence on contrast-enhanced CT of pancreatic ductal adenocarcinoma

The purpose of our study was to examine the influence of the histology of pancreatic ductal adenocarcinoma on its appearance with contrast-enhanced CT. Early-phase and late-phase dynamic CT images were obtained in 34 patients who underwent pancreaticoduodenostomy. The attenuating areas of the tumors (n = 58) on early- and late-phase images were classified as hyperattenuated, isoattenuated, hypoattenuated, or unenhanced. The histologic findings of these lesions were compared to the CT appearances. The isoattenuated areas on both early- and late-phase images histologically showed increasing cellularity of tumor cells (n = 1) or coexisting acinar tissues and tumor cells (n = 2) within the tumor. Hypoattenuated areas on early-phase images and isoattenuated or hyperattenuated areas on late-phase images (n = 27) showed dense fibrosis except in one tumor with an abscess. Hypoattenuated areas on early- and late-phase images and unenhanced areas (n = 28) showed mucin and/or necrosis within the tumor. The contrast-enhanced CT appearance of pancreatic ductal adenocarcinoma is influenced by the histologic features associated with tumor cells.