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.