本前瞻性多中心研究旨在评估80 kVp薄层胰腺CT在根据最近的全国综合癌症网络（NCCN）指南确定胰管腺癌（PDAC）可切除性中的诊断表现。我们从六家三级转诊医院中招募了手术切除候选者以进行PDAC研究（研究标识符：NCT03895177）。所有参与者均接受使用80 kVp管电压和1 mm重建间隔的胰腺CT。在每个中心使用NCCN指南进行局部可切除性的前瞻性评估并分为三类：可切除、边缘可切除和不可切除。共招募了138名患者，其中60名患者接受了新辅助治疗。103名患者（74.6%）实现了R0切除。在78名接受直接手术的患者中，可切除、边缘可切除和不可切除疾病的R0切除率分别为88.7%（47/53）、52.4%（11/21）和0.0%（0/4）。与此同时，在接受新辅助治疗的患者中，可切除、边缘可切除和不可切除PDAC的R0切除率分别为90.9%（20/22）、76.7%（23/30）和25.0%（2/8）。高分辨率CT在预测R0切除方面的曲线下面积为0.784，其敏感性、特异性和准确性分别为87.4%（90/103）、48.6%（17/35）和77.5%（107/138）。肿瘤反应与新辅助治疗后的R0切除显著相关（比值比[OR]为38.99，p=0.016）。80 kVp薄层胰腺CT在评估PDAC可切除性方面具有良好的诊断表现，使可切除PDAC接受直接手术和新辅助治疗后的患者的R0切除率分别达到88.7%和90.9%。• 在78名接受直接手术的患者中，根据80 kVp薄层胰腺CT，胰管腺癌（PDAC）的无残缺（R0）切除率分别为可切除、边缘可切除和不可切除疾病的R0切除率为88.7%（47/53）、52.4%（11/21）和0.0%（0/4）。 • 在接受新辅助治疗的60名患者中，可切除、边缘可切除和不可切除PDAC的R0率分别为90.9%（20/22）、76.7%（23/30）和25.0%（2/8）。 • 肿瘤反应以及胰腺CT评估的可切除性，与新辅助治疗后的R0切除率显著相关。©2023年。作者（s）独家授权欧洲放射学会。

This prospective multicenter study aimed to evaluate the diagnostic performance of 80-kVp thin-section pancreatic CT in determining pancreatic ductal adenocarcinoma (PDAC) resectability according to the recent National Comprehensive Cancer Network (NCCN) guidelines.We prospectively enrolled surgical resection candidates for PDAC from six tertiary referral hospitals (study identifier: NCT03895177). All participants underwent pancreatic CT using 80 kVp tube voltage with 1-mm reconstruction interval. The local resectability was prospectively evaluated using NCCN guidelines at each center and classified into three categories: resectable, borderline resectable, and unresectable.A total of 138 patients were enrolled; among them, 60 patients underwent neoadjuvant therapy. R0 resection was achieved in 103 patients (74.6%). The R0 resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable disease, respectively, in 78 patients who underwent upfront surgery. Meanwhile, the rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively, in patients who received neoadjuvant therapy. The area under curve of high-resolution CT in predicting R0 resection was 0.784, with sensitivity, specificity, and accuracy of 87.4% (90/103), 48.6% (17/35), and 77.5% (107/138), respectively. Tumor response was significantly associated with the R0 resection after neoadjuvant therapy (odds ratio [OR] = 38.99, p = 0.016).An 80-kVp thin-section pancreatic CT has excellent diagnostic performance in assessing PDAC resectability, enabling R0 resection rates of 88.7% and 90.9% for patients with resectable PDAC who underwent upfront surgery and patients with resectable PDAC after neoadjuvant therapy, respectively.• The margin-negative (R0) resection rates were 88.7% (47/53), 52.4% (11/21), and 0.0% (0/4) for resectable, borderline resectable, and unresectable pancreatic ductal adenocarcinoma (PDAC), respectively, on 80-kVp thin-section pancreatic CT in the 78 patients who underwent upfront surgery. • Among the 60 patients who underwent neoadjuvant therapy, the R0 rates were 90.9% (20/22), 76.7% (23/30), and 25.0% (2/8) for resectable, borderline resectable, and unresectable PDAC, respectively. • Tumor response, along with the resectability status on pancreatic CT, was significantly associated with the R0 resection rate after neoadjuvant therapy.© 2023. The Author(s), under exclusive licence to European Society of Radiology.