Purpose: In pancreatic adenocarcinoma, the difficult distinction between normal and affected pancreas on CT studies may lead to discordance between the pre-surgical assessment of vessel involvement and intraoperative findings. We hypothesize that a visual aid tool could improve the performance of radiology residents when detecting vascular invasion in pancreatic adenocarcinoma patients. Methods: This study consisted of 94 pancreatic adenocarcinoma patient CTs. The visual aid compared the estimated body fat density of each patient with the densities surrounding the superior mesenteric artery and mapped them onto the CT scan. Four radiology residents annotated the locations of perceived vascular invasion on each scan with the visual aid overlaid on alternating scans. Using 3 expert radiologists as the reference standard, we quantified the area under the receiver operating characteristic curve to determine the performance of the tool. We then used sensitivity, specificity, balanced accuracy ((sensitivity + specificity)/2), and spatial metrics to determine the performance of the residents with and without the tool. Results: The mean area under the curve was 0.80. Radiology residents' sensitivity/specificity/balanced accuracy for predicting vascular invasion were 50%/85%/68% without the tool and 81%/79%/80% with it compared to expert radiologists, and 58%/85%/72% without the tool and 78%/77%/77% with it compared to the surgical pathology. The tool was not found to impact the spatial metrics calculated on the resident annotations of vascular invasion. Conclusion: The improvements provided by the visual aid were predominantly reflected by increased sensitivity and accuracy, indicating the potential of this tool as a learning aid for trainees.
Keywords: CT; pancreatic cancer; radiology residents; superior mesenteric artery; visual aid tool.