ArticleQuantitative imaging in medicine and surgery2026
Differentiating pancreatic acinar cell carcinoma from solid pseudopapillary neoplasm using contrast-enhanced computed tomography.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Solid pseudopapillary neoplasm (SPN) and pancreatic acinar cell carcinoma (PACC) represent two uncommon pancreatic tumors with distinct biological behaviors and management strategies. Both entities can present with overlapping appearances on contrast-enhanced computed tomography (CECT), posing a diagnostic challenge preoperatively. Therefore, reliable imaging differentiation between these tumors is clinically important. This study aimed to evaluate computed tomography (CT) imaging features for differentiating SPN from PACC and to develop a combined model to improve preoperative diagnostic performance. Methods: We retrospectively reviewed 68 patients (51 SPN, 17 PACC) who underwent preoperative CECT. Clinical and CT imaging features were compared between groups. Variables that were significant in univariate analysis were entered into a forward stepwise multivariable logistic regression model to identify independent predictors. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and differences between ROC curves were compared using the DeLong test. Results: Patients with PACC were significantly older and more likely to be male than those with SPN (both P<0.001). The tumor-to-pancreas enhancement ratio in the pancreatic parenchymal phase (PPP) was significantly higher in PACC (P=0.004). The "floating cloud" sign was observed more frequently in SPN (P=0.010), whereas pancreatic duct dilation occurred more frequently in PACC (P=0.004). Multivariate analysis identified the tumor-to-pancreas enhancement ratio in the PPP [odds ratio (OR) =1.10; P=0.002] and pancreatic duct dilation (OR =4.65; P=0.036) as independent predictors of PACC, whereas the "floating cloud" sign was independently associated with SPN (OR =0.12;P=0.010). The combined model achieved the highest area under the curve (AUC) among all evaluated diagnostic models in this cohort (AUC =0.865). Conclusions: A combined assessment incorporating the tumor-to-pancreas enhancement ratio in the PPP, the "floating cloud" sign, and pancreatic duct dilation may improve preoperative differentiation between PACC and SPN.
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