Correlation Between Enhancement Patterns on Transabdominal Ultrasound and Survival for Pancreatic Ductal Adenocarcinoma

Figures & data

Figure 1 Flow diagram of patient inclusion and exclusion.

Table 1 Patients’ Clinical Data, with Comparisons Between the Data for the Two PDAC Patient Groups with Different CEUS Enhancement Patterns (n = 56) and for the Patients with Different Degrees of Differentiation (n = 26)

	Clinical Data (n = 56)		Different CEUS Enhancement Patterns (n = 56)			Different Degrees of Differentiation (n = 26)
		Mean or Percentage	Hypo-Enhancement*	Iso-Enhancement*	P value	Well-Differentiated	Moderately to Poorly Differentiated	P value
Sex	Male	35 (62.5%)	26(66.7%)	9(52.9%)	0.338	7 (58.3%)	10 (71.4%)	0.504
	Female	21 (37.5%)	13 (33.3%)	8 (47.1%)		5 (41.7%)	4 (28.6%)
Age at disease onset (years)		56.40 ± 11.57	56.64 ± 11.15	56.67 ± 12.15		54.50 ± 11.45	55.71 ± 12.76	0.802
Maximum tumour diameter (cm)		4.74 ± 1.23 cm	4.78 ± 1.06	4.72 ± 1.57	0.999	4.84 ± 1.28	4.84 ± 1.63	0.992
CA19-9* (U/mL)	Mean value	427.45 (61.25, 1883.25)	427.45 (61.25, 1883.25)	203.15 (35.33, 678.30)	0.944	349.25 (39.33, 2067.25)	47.7 (13.70, 406.20)	0.098
	≥1000.0	12 (21.4%)	–	–	–	–	–	–
	34.0–1000.0	32 (57.1%)	–	–	–	–	–	–
	0–34.0	7 (12.5%)	–	–	–	–	–	–
Colour Doppler blood flow signals	Some blood flow signals	–	29	14	0.294
	No blood flow signals	–	11	2	0.230
Enhancement pattern								0.756
	Iso-enhancement					5	5
	Hypo-enhancement					7	9

Notes: *The CA19-9 level was unavailable for five patients (because examinations were performed at other hospitals). *For enhancement patterns, necrotic areas of lesions were excluded, chi-square tests were used for between-group comparisons of percentages, and t-tests were used for between-group comparisons of normally distributed data. For differentiation-based comparisons, chi-square tests were used for between-group comparisons of percentages, and t-tests were used for between-group comparisons of normally distributed data.

Figure 2 CEUS enhancement patterns in the arterial phase in PDAC. (A and B): A 53-year-old male patient with PDAC located in the head of the pancreas. Rapid iso-enhancement was observed in the arterial phase of CEUS (18 s) (as shown by the white arrows). (C and D): A 42 year-old male patient with PDAC located in the  body of the pancreas. Hypo-enhancement was observed in the arterial phase of CEUS (15 s), and no areas of enhancement were visible within the tumour (as shown by the white arrows).

Table 2 Comparison of Sex, Age at Disease Onset, Size of Lesions, and CA19-9 Level for PDAC Patients with Different Enhancement Patterns

	Hypo-Enhancement*	Iso-Enhancement*	X2/T	P value
Sex			0.81	0.368
Female	13 (36.1%)	7 (50%)
Male	23 (63.9%)	7 (50%)
Age at disease onset (years)	56.39 ± 11.47	56.43 ± 12.26	−0.011	0.991
Maximum tumour diameter (cm)	4.63 ± 0.97	4.71 ± 1.25	−0.222	0.825
CA19-9 (U/mL)	427.45 (61.25, 1883.25)	203.15 (35.33, 678.30)	0.982	0.331

Notes: *For enhancement patterns, necrotic areas of lesions were excluded, chi-square tests were used for between-group comparisons of percentages, and t-tests were used for between-group comparisons of normally distributed data.

Table 3 Survival of PDAC Patients with Different Enhancement Patterns Based on Follow-Up Results

Enhancement Pattern	Number of Survivors	Number of Deaths	Median Survival Time (Days)	Chi-Square	P value
Hypo-enhancement	7	29	321.0 ± 205.5	8.142	0.004
Iso-enhancement	4	10	627.1 ± 311.6

Note: Cox regression was used.

Figure 3 Survival analysis of the hypo- and iso-enhancement groups.

Table 4 Comparison of TIC Parameters Between Different CEUS Enhancement Patterns of PDAC

	Hypo-Enhancement	Iso-Enhancement	P value
Peaknormal	59.77 ± 12.3	55.03 ± 11.88	0.849
TPnormal (ms)	32,198.5 (22,288, 35,984.5)	27,215 (24,039, 34,010)	0.320
Sharpnessnormal (l/s)	0.07 (0.04, 0.11)	0.06 (0.04, 0.08)	0.604
AUCnormal (l/s)	4.15 (2.55, 5.95)	2.95 (2.1, 4.1)	0.170
Peaktumour	38.9 (35.8, 44.1)	49.4 (46, 59.4)	<0.001
TPtumour (ms)	26,706.33 ± 12,701.85	28,119.14 ± 7769.61	0.235
Sharpnesstumour (l/s)	0.12 (0.09, 0.22)	0.08 (0.06, 0.12)	0.006
AUCtumour (l/s)	4.9 (2.95, 8)	4.1 (3.1, 5.6)	0.239
AEpeak	20.45 ± 11.11	2.51 ± 6.06	0.013
REpeak	0.33 ± 0.16	0.03 ± 0.10	0.288
AETP (ms)	3685 (−3902, 9994)	613 (−5147, 4503)	0.202
RETP	0.13 (−0.19, 0.37)	0.02 (−0.22, 0.13)	0.195
AEsharpness (l/s)	−0.07 (−0.14, −0.04)	−0.02 (−0.04, 0)	0.001
REsharpness	−1.06 (−2.37, −0.51)	−0.29 (−0.91, 0.05)	0.009
AEAUC (l/s)	−1.12 ± 3.34	−0.53 ± 2.19	0.273
REAUC	−0.2 (−1.33, 0.09)	−0.42 (−0.85, 0.04)	0.897

Notes: For between-group comparisons, t-tests and the Mann–Whitney U-test were used for normally and non-normally distributed data, respectively.