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. 2025 May 6;17(5):e83606.
doi: 10.7759/cureus.83606. eCollection 2025 May.

Role of Multiphasic Computed Tomography in the Evaluation of Neoplastic Pancreatic Masses: A Single-Center Observational Study

Prajwal Tr  1 , Umakant Prasad  1 , Deepak Kumar  1 , Neetu Sinha  1 , Rashmi R Bharti  2 , Rakesh Kumar Singh  3 , Ankita Kumari  1
Affiliations

Role of Multiphasic Computed Tomography in the Evaluation of Neoplastic Pancreatic Masses: A Single-Center Observational Study

Prajwal Tr et al. Cureus. .

Abstract

Background: Pancreatic neoplasms are associated with high morbidity and mortality, largely due to late diagnosis and challenges in accurate staging. Multiphasic computed tomography (CT) is a critical imaging tool for evaluating pancreatic masses offering detailed information on lesion characterization and surgical resectability. Precise radiological assessment is vital for treatment planning, and correlating imaging findings with histopathology improves diagnostic efficiency.

Methods: This prospective study was conducted on 50 patients with clinically suspected pancreatic neoplasms who underwent multiphasic CT imaging. Non-contrast, late arterial (pancreatic phase), and portal venous phase images were acquired following standardized contrast-enhanced CT protocols. Lesions were evaluated for size, morphology, enhancement patterns, vascular involvement, and local invasion. Resectability was assessed according to the Dutch Pancreatic Cancer Group (DPCG) criteria. Imaging findings were correlated with the final histopathological diagnosis to determine diagnostic sensitivity and specificity.

Results: In the vast majority of cases, 43 out of 50 (86%) were diagnosed as adenocarcinoma. Other diagnoses, such as mucinous cystadenoma, solid pseudo-papillary epithelial neoplasm (SPEN), and neuroendocrine tumor, were very uncommon, each making up 4% of the total cases. Multiphasic CT showed excellent sensitivity and specificity of 100% and 85.7%, respectively, in diagnosing pancreatic neoplasms. Out of 50 cases, 16 cases were found to be resectable, 10 cases were borderline resectable, and 24 cases were non-resectable, out of which 15 cases showed distant metastasis.

Conclusion: Multiphasic CT is a highly accurate, non-invasive modality for the evaluation and characterization of pancreatic masses. It demonstrates a strong correlation with histopathological findings, reliably assesses vascular involvement, and predicts resectability according to DPCG criteria. Therefore, early and accurate CT-based evaluation is critical for optimal treatment planning and improving patient outcomes.

Keywords: common bile duct; lymph node; main pancreatic duct; metastasis; multiphasic computed tomography; pancreatic adenocarcinoma; superior mesenteric artery; superior mesenteric vein.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Indira Gandhi Institute of Medical Sciences (IGIMS) Institutional Ethics Committee issued approval 625/IEC/IGIMS/2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. (A) Contrast-enhanced CT scan image of the abdomen in the arterial phase shows a mildly enhancing solid mass in the head of the pancreas encasing the celiac trunk, splenic artery, and common hepatic artery (precontrast HU-47, postcontrast HU-65). (B) Microscopic section of the pancreas shows infiltrating well- to poorly formed glandular/ductal structures surrounded by remarkably desmoplastic stroma (H&E stain, original magnification 10×). It was conformed to be a case of adenocarcinoma of the head of the pancreas
CT: computed tomography; H&E: hematoxylin and eosin; HU: Hounsfield units
Figure 2
Figure 2. (A) Axial contrast-enhanced CT scan image of the abdomen in portal venous phase at the level of the pancreas shows a well-defined solid cystic mass in the body and tail of the pancreas. (B) Microscopic section of the pancreas shows tumor cells arranged in solid and pseudo-papillary pattern, solid areas comprising monomorphic cells admixed with capillary-sized blood vessels, and pseudo-papillae formed by tumor cells around the blood vessels, getting detached at places (H&E stain, original magnification 20×). It was proven to be a case of SPEN
CT: computed tomography; H&E: hematoxylin and eosin; SPEN: solid pseudo-papillary epithelial neoplasm
Figure 3
Figure 3. Plain (A) and portal venous phase of contrast-enhanced (B) axial CT scan images show a thick-walled hypodense cystic lesion with tiny focus of calcification at the periphery. On HPE, it was proven to be a case of mucinous cystadenoma of the pancreas
CT: computed tomography; HPE: histopathological examination
Figure 4
Figure 4. (A) Axial contrast-enhanced CT scan image in arterial phase demonstrates small hyperenhancing lesion in the tail of the pancreas. (B) Solid nests, trabeculae, and cords of tumor cells having eosinophilic to amphophilic, finely granular cytoplasm and monomorphic centrally located round to oval nuclei with salt and pepper appearance (H&E stain, original magnification 40×). It was determined to be a case of insulinoma
CT: computed tomography; H&E: hematoxylin and eosin
Figure 5
Figure 5. Histogram showing the distribution of aberrant artery anatomy in patient with pancreatic mass
Figure 6
Figure 6. Histogram showing the frequency distribution of pancreatic mass resectability in patients with pancreatic mass
See this image and copyright information in PMC

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