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Fukukura Y, Kanki A. Quantitative Magnetic Resonance Imaging for the Pancreas: Current Status. Invest Radiol 2024; 59:69-77. [PMID: 37433065 DOI: 10.1097/rli.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is important for evaluating pancreatic disorders, and anatomical landmarks play a major role in the interpretation of results. Quantitative MRI is an effective diagnostic modality for various pathologic conditions, as it allows the investigation of various physical parameters. Recent advancements in quantitative MRI techniques have significantly improved the accuracy of pancreatic MRI. Consequently, this method has become an essential tool for the diagnosis, treatment, and monitoring of pancreatic diseases. This comprehensive review article presents the currently available evidence on the clinical utility of quantitative MRI of the pancreas.
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Affiliation(s)
- Yoshihiko Fukukura
- From the Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
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Identification of intratumoral fluid-containing area by magnetic resonance imaging to predict prognosis in patients with pancreatic ductal adenocarcinoma after curative resection. Eur Radiol 2021; 32:2518-2528. [PMID: 34671833 DOI: 10.1007/s00330-021-08328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the prognosis of pancreatic ductal adenocarcinoma (PDAC) after curative resection according to the type of intratumoral fluid-containing area identified on MRI. METHODS This retrospective study included 112 consecutive patients who underwent upfront surgery with margin-negative resection between 2012 and 2019. All patients underwent MRI within 1 month before surgery. Three radiologists independently assessed the MRI findings, determined whether intratumoral fluid-containing areas were present, and classified all intratumoral fluid-containing areas by type (i.e., imaging necrosis or neoplastic mucin cysts). Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan-Meier method and the Cox proportional hazards model. Histopathological differences according to the type of intratumoral fluid-containing area were assessed. RESULTS Of the 112 PDAC patients, intratumoral fluid-containing areas were identified on MRI in 33 (29.5%), among which 18 were classified as imaging necrosis and 15 as neoplastic mucin cysts. PDAC patients with imaging necrosis demonstrated significantly shorter RFS (mean 6.1 months versus 47.3 months; p < .001) and OS (18.4 months versus 55.0 months, p = .001) than those with neoplastic mucin cysts. Multivariable analysis showed that only the type of intratumoral fluid-containing area was significantly associated with RFS (hazard ratio, 2.25 and 0.38; p = .009 and p = .046 for imaging necrosis and neoplastic mucin cysts, respectively). PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts (p ≤ .02). CONCLUSION The detection and discrimination of intratumoral fluid-containing areas on preoperative MRI may be useful in predicting the prognosis of PDAC patients after curative resection. KEY POINTS • Pancreatic ductal adenocarcinoma (PDAC) patients with imaging necrosis demonstrated significantly shorter survival than those with neoplastic mucin cysts after curative resection. • Multivariable analysis showed that only the type of intratumoral fluid-containing area identified on MRI was significantly associated with recurrence-free survival. • PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts.
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Jeon SK, Jang JY, Kwon W, Kim H, Han Y, Kim D, Park D, Kim JH. Diffusion-weighted MR imaging in pancreatic ductal adenocarcinoma: prediction of next-generation sequencing-based tumor cellularity and prognosis after surgical resection. Abdom Radiol (NY) 2021; 46:4787-4799. [PMID: 34143259 DOI: 10.1007/s00261-021-03177-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify features on preoperative MR imaging with diffusion-weighted imaging (DWI) for predicting next-generation sequencing (NGS)-based tumor cellularity and patient outcome after surgical resection of pancreatic ductal adenocarcinoma (PDAC). METHODS This retrospective study included 105 patients with surgically resected PDAC who underwent preoperative MR imaging with DWI. Tumor cellularity was measured using molecular techniques and bioinformatics methods. Clinico-pathologic findings including tumor T stage for predicting disease-free survival (DFS) and overall survival (OS) were identified using Cox proportional hazards model. Important MR imaging findings including apparent diffusion coefficient (ADC) value of PDAC and modified ADC value (the ratio of the ADC value of PDAC to the ADC value of the spleen) for predicting higher tumor cellularity (≥ 30%) and poor prognosis were also identified. RESULTS The median DFS and OS were 12.0 months [95% confidence interval (CI), 8.0-17.0] and 22.0 months (95% CI, 18.0-29.0), respectively. Higher T stage (T3/4) [hazard ratio (HR), 7.720, (95% CI 1.072, 55.612); p = 0.048] and higher tumor cellularity [HR, 1.599 (95% CI, 1.003-2.548); p = 0.048] were significantly associated with worse DFS. Among MR imaging features, the modified ADC value was significantly associated with tumor cellularity [odds ratio, 0.068 (95% CI, 0.012-0.372); p = 0.002], and PDAC with lower modified ADC value [≤ 1.40 (cutoff value)] showed significantly shorter median DFS than PDAC with higher modified ADC value [8 months (95% CI, 4-12) vs. 16 months (95% CI, 10-29); HR, 1.713 (95% CI, 1.073-2.735), log-rank p = 0.024]. CONCLUSION Higher NGS-based tumor cellularity may be a negative prognostic factor in pancreatic cancer after resection, and modified ADC value derived from DWI could be helpful in predicting tumor cellularity and patient surgical outcome with regard to recurrence.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Daeun Kim
- Department of Biological Sciences, College of Natural Sciences, Ajou University, Suwon, 16499, Republic of Korea
| | - Daechan Park
- Department of Biological Sciences, College of Natural Sciences, Ajou University, Suwon, 16499, Republic of Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Harrington KA, Shukla-Dave A, Paudyal R, Do RKG. MRI of the Pancreas. J Magn Reson Imaging 2020; 53:347-359. [PMID: 32302044 DOI: 10.1002/jmri.27148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
MRI has played a critical role in the evaluation of patients with pancreatic pathologies, from screening of patients at high risk for pancreatic cancer to the evaluation of pancreatic cysts and indeterminate pancreatic lesions. The high mortality associated with pancreatic adenocarcinomas has spurred much interest in developing effective screening tools, with MRI using magnetic resonance cholangiopancreatography (MRCP) playing a central role in the hopes of identifying cancers at earlier stages amenable to curative resection. Ongoing efforts to improve the resolution and robustness of imaging of the pancreas using MRI may thus one day reduce the mortality of this deadly disease. However, the increasing use of cross-sectional imaging has also generated a concomitant clinical conundrum: How to manage incidental pancreatic cystic lesions that are found in over a quarter of patients who undergo MRCP. Efforts to improve the specificity of MRCP for patients with pancreatic cysts and with indeterminate pancreatic masses may be achieved with continued technical advances in MRI, including diffusion-weighted and T1 -weighted dynamic contrast-enhanced MRI. However, developments in quantitative MRI of the pancreas remain challenging, due to the small size of the pancreas and its upper abdominal location, adjacent to bowel and below the diaphragm. Further research is needed to improve MRI of the pancreas as a clinical tool, to positively affect the lives of patients with pancreatic abnormalities. This review focuses on various MR techniques such as MRCP, quantitative imaging, and dynamic contrast-enhanced imaging and their clinical applicability in the imaging of the pancreas, with an emphasis on pancreatic malignant and premalignant lesions. Level of Evidence 5 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:347-359.
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Affiliation(s)
- Kate A Harrington
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramesh Paudyal
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cui SJ, Tang TY, Zou XW, Su QM, Feng L, Gong XY. Role of imaging biomarkers for prognostic prediction in patients with pancreatic ductal adenocarcinoma. Clin Radiol 2020; 75:478.e1-478.e11. [PMID: 32037002 DOI: 10.1016/j.crad.2019.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive tumours. PDAC has a poor prognosis; therefore, it is necessary to perform further risk stratification. Identifying prognostic factors before treatment might help to implement suitable and personalised treatment for individuals and avoid side effects. Conventional staging systems and tumour biomarkers are fundamental to establish prognosis; however, they have obvious limitations. Novel imaging biomarkers extracted from advanced imaging techniques offer opportunities to evaluate underlying tumour physiological characteristics, such as mutational status, cellular composition, local microenvironment, tumour metabolism, and biological behaviour. Thus, imaging biomarkers might help the decision making of oncologists and surgeons. The present review discusses the functions of imaging biomarkers for prognostic prediction in patients with PDAC and their potential value for further translation in clinical practice.
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Affiliation(s)
- S-J Cui
- The Second Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, China; Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, 310013, Hangzhou, China
| | - T-Y Tang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - X-W Zou
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China
| | - Q-M Su
- Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - L Feng
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - X-Y Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, 310013, Hangzhou, China; Institute of Artificial Intelligence and Remote Imaging, Hangzhou Medical College, 310000, Hangzhou, China.
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Abdel Kader M, Abass HR, Suliman MM. Apparent diffusion coefficient of pancreatic adenocarcinoma: is there any congruity with tumor resectability? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chouhan MD, Firmin L, Read S, Amin Z, Taylor SA. Quantitative pancreatic MRI: a pathology-based review. Br J Radiol 2019; 92:20180941. [PMID: 30982337 DOI: 10.1259/bjr.20180941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
MRI plays an important role in the clinical management of pancreatic disorders and interpretation is reliant on qualitative assessment of anatomy. Conventional sequences capturing pancreatic structure can however be adapted to yield quantitative measures which provide more diagnostic information, with a view to increasing diagnostic accuracy, improving patient stratification, providing robust non-invasive outcome measures for therapeutic trials and ultimately personalizing patient care. In this review, we evaluate the use of established techniques such as secretin-enhanced MR cholangiopancreatography, diffusion-weighted imaging, T 1, T 2* and fat fraction mapping, but also more experimental methods such as MR elastography and arterial spin labelling, and their application to the assessment of diffuse pancreatic disease (including chronic, acute and autoimmune pancreatitis/IgG4 disease, metabolic disease and iron deposition disorders) and cystic/solid focal pancreatic masses. Finally, we explore some of the broader challenges to their implementation and future directions in this promising area.
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Affiliation(s)
- Manil D Chouhan
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Louisa Firmin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Samantha Read
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Zahir Amin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Stuart A Taylor
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
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Siddiqui N, Vendrami CL, Chatterjee A, Miller FH. Advanced MR Imaging Techniques for Pancreas Imaging. Magn Reson Imaging Clin N Am 2019; 26:323-344. [PMID: 30376973 DOI: 10.1016/j.mric.2018.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in MR imaging with optimization of hardware, software, and techniques have allowed for an increased role of MR in the identification and characterization of pancreatic disorders. Diffusion-weighted imaging improves the detection and staging of pancreatic neoplasms and aides in the evaluation of acute, chronic and autoimmune pancreatitis. The use of secretin-enhanced MR cholangiography improves the detection of morphologic ductal anomalies, and assists in the characterization of pancreatic cystic lesions and evaluation of acute and chronic pancreatitis. Emerging MR techniques such as MR perfusion, T1 mapping/relaxometry, and MR elastography show promise in further evaluating pancreatic diseases.
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Affiliation(s)
- Nasir Siddiqui
- Department of Radiology, DuPage Medical Group, 430 Warrenville Road, Lisle, IL 60532, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Argha Chatterjee
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA.
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Lee S, Kim SH, Park HK, Jang KT, Hwang JA, Kim S. Pancreatic Ductal Adenocarcinoma: Rim Enhancement at MR Imaging Predicts Prognosis after Curative Resection. Radiology 2018; 288:456-466. [DOI: 10.1148/radiol.2018172331] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sunyoung Lee
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Hyung Kyu Park
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Kee Taek Jang
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Jeong Ah Hwang
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
| | - Seonwoo Kim
- From the Department of Radiology and Center for Imaging Science (S.L., S.H.K., J.A.H.), Department of Pathology (H.K.P., K.T.J.), and Department of Statistics and Data Center (S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea
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Zhang Y, Zhu X, Liu D, Song J, Zhang H, Lu J. Pre-treatment DWI as a predictor of overall survival in locally advanced pancreatic cancer treated with Cyberknife radiotherapy and sequential S-1 therapy. Cancer Imaging 2018; 18:6. [PMID: 29471875 PMCID: PMC5824450 DOI: 10.1186/s40644-018-0139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background To identify the value of the pre-treatment apparent diffusion coefficient (ADC) derived from diffusion weighted imaging (DWI) in predicting the overall survival (OS) for locally advanced pancreatic cancer (LAPC) treated with Cyberknife followed by sequential S-1 chemotherapy. Methods Patients with UICC-T4 LAPC who underwent DWI scan (3.0 Tesla) using two b-values (0, 600 s/mm2) in our center between 2015 and 2017 were enrolled. Mean ADCs of the region of interest (ROI) drawn manually on DWI imaging were measured by two independent radiologists at an interval of 1 month. The association between prognostic factors and patient survival was determined using univariate and multivariate analyses. Cox proportional hazard model was used for identification of independent prognostic factors of OS. Results A total of 41 patients (28 males and 13 females) were included, with a median age of 64 years, with 5 patients (3 males and 2 females) lost. The median OS was 11.7 months (range 2.8–23.3) among all 41 patients. The 1-year OS was 46% (95% CI 30%–62%). Univariate and multivariate analyses indicated that pre-treatment ADC value (HR 10.652, P = 0.0093), age (HR 0.952, P = 0.015), CA19–9 (HR 1.001, P = 0.0022) and administration of S-1 (HR 0.128, P = 0.0002) were independent predicting factors of OS. Conclusion The mean ADC value of the primary tumor on pre-treatment DWI imaging was an independent predictor of OS in patients with LAPC receiving Cyberknife followed by sequential S-1.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu district, Shanghai, 200433, People's Republic of China
| | - Xiaofei Zhu
- Department of Oncology Radiation, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu district, Shanghai, 200433, People's Republic of China
| | - Denghui Liu
- Department of Orthopedics, No. 113 Hospital of People's Liberation Army, East Zhongshan Road 377, Jiangdong District, Ningbo, 315000, People's Republic of China
| | - Jiaqi Song
- Department of health statistics, Second Military Medical University, Xiangyin Road 800, Yangpu district, Shanghai, 200433, People's Republic of China
| | - Huojun Zhang
- Department of Oncology Radiation, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu district, Shanghai, 200433, People's Republic of China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu district, Shanghai, 200433, People's Republic of China.
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Mayer P, Dinkic C, Jesenofsky R, Klauss M, Schirmacher P, Dapunt U, Hackert T, Uhle F, Hänsch GM, Gaida MM. Changes in the microarchitecture of the pancreatic cancer stroma are linked to neutrophil-dependent reprogramming of stellate cells and reflected by diffusion-weighted magnetic resonance imaging. Theranostics 2018; 8:13-30. [PMID: 29290790 PMCID: PMC5743457 DOI: 10.7150/thno.21089] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/13/2017] [Indexed: 01/06/2023] Open
Abstract
In pancreatic cancer (PDAC) intratumor infiltration of polymorphonuclear neutrophils (PMN) is associated with histologically apparent alterations of the tumor growth pattern. The aim of this study was to examine possible associations between PMN infiltration, tumor microarchitecture, and water diffusivity in diffusion-weighted magnetic resonance imaging (DW-MRI), and to further asses the underlying mechanisms. Methods: DW-MRI was performed in 33 PDAC patients prior to surgery. In parallel, tissue specimen were examined histologically for growth pattern, azurocidin-positive PMN infiltrates, and the presence of alpha-smooth muscle actin (α-SMA) and metalloproteinase 9 (MMP9)-positive myofibroblastic cells. For confirmation of the histological findings, a tissue microarray of a second cohort of patients (n=109) was prepared and examined similarly. For in vitro studies, the pancreatic stellate cell line RLT was co-cultivated either with isolated PMN, PMN-lysates, or recombinant azurocidin and characterized by Western blot, flow cytometry, and proteome profiler arrays. Results: Tumors with high PMN density showed restricted water diffusion in DW-MRI and histologic apparent alterations of the tumor microarchitecture (microglandular, micropapillary, or overall poorly differentiated growth pattern) as opposed to tumors with scattered PMN. Areas with altered growth pattern lacked α-SMA-positive myofibroblastic cells. Tissue microarrays confirmed a close association of high PMN density with alterations of the tumor microarchitecture and revealed a significant association of high PMN density with poor histologic grade of differentiation (G3). In vitro experiments provided evidence for direct effects of PMN on stellate cells, where a change to a spindle shaped cell morphology in response to PMN and to PMN-derived azurocidin was seen. Azurocidin incorporated into stellate cells, where it associated with F-actin. Down-regulation of α-SMA was seen within hours, as was activation of the p38-cofilin axis, up-regulation of MMP9, and acquisition of intracellular lipid droplets, which together indicate a phenotype switch of the stellate cells. Conclusion: In PDAC, PMN infiltrates are associated with alterations of the tumor microarchitecture. As a causal relationship, we propose a reprogramming of stellate cells by PMN-derived azurocidin towards a phenotype, which affects the microarchitecture of the tumor.
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Trajkovic-Arsic M, Heid I, Steiger K, Gupta A, Fingerle A, Wörner C, Teichmann N, Sengkwawoh-Lueong S, Wenzel P, Beer AJ, Esposito I, Braren R, Siveke JT. Apparent Diffusion Coefficient (ADC) predicts therapy response in pancreatic ductal adenocarcinoma. Sci Rep 2017; 7:17038. [PMID: 29213099 PMCID: PMC5719052 DOI: 10.1038/s41598-017-16826-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/17/2017] [Indexed: 01/05/2023] Open
Abstract
Recent advances in molecular subtyping of Pancreatic Ductal Adenocarcinoma (PDAC) support individualization of therapeutic strategies in this most aggressive disease. With the emergence of various novel therapeutic strategies and neoadjuvant approaches in this quickly deteriorating disease, robust approaches for fast evaluation of therapy response are urgently needed. To this aim, we designed a preclinical imaging-guided therapy trial where genetically engineered mice harboring endogenous aggressive PDAC were treated with the MEK targeting drug refametinib, which induces rapid and profound tumor regression in this model system. Multi-parametric non-invasive imaging was used for therapy response monitoring. A significant increase in the Diffusion-Weighted Magnetic Resonance Imaging derived Apparent Diffusion Coefficient (ADC) was noted already 24 hours after treatment onset. Histopathological analyses showed increased apoptosis and matrix remodeling at this time point. Our findings suggest the ADC parameter as an early predictor of therapy response in PDAC.
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Affiliation(s)
- M Trajkovic-Arsic
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - I Heid
- Institute of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - K Steiger
- Institute of Pathology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - A Gupta
- 2. Medizinische Klinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Fingerle
- Institute of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Wörner
- Institute of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - N Teichmann
- 2. Medizinische Klinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - S Sengkwawoh-Lueong
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Wenzel
- 2. Medizinische Klinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - A J Beer
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany
| | - I Esposito
- Institute of Pathology, University Clinic Duesseldorf, Heinrich-Heine University, Duesseldorf, Germany
| | - R Braren
- Institute of Radiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - J T Siveke
- Division of Solid Tumor Translational Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.
- German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- 2. Medizinische Klinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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Nissan N. Modifications of pancreatic diffusion MRI by tissue characteristics: what are we weighting for? NMR IN BIOMEDICINE 2017; 30:e3728. [PMID: 28470823 DOI: 10.1002/nbm.3728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Diffusion-weighted imaging holds the potential to improve the diagnosis and biological characterization of pancreatic disease, and in particular pancreatic cancer, which exhibits decreased values of the apparent diffusion coefficient (ADC). Yet, variable and overlapping ADC values have been reported for the healthy and the pathological pancreas, including for cancer and other benign conditions. This controversy reflects the complexity of probing the water-diffusion process in the pancreas, which is dependent upon multiple biological factors within this organ's unique physiological environment. In recent years, extensive studies have investigated the correlation between tissue properties including cellularity, vascularity, fibrosis, secretion and microstructure and pancreatic diffusivity. Understanding how the various physiological and pathological features and the underlying functional processes affect the diffusion measurement may serve to optimize the method for improved diagnostic gain. Therefore, the aim of the present review article is to elucidate the relationship between pancreatic tissue characteristics and diffusion MRI measurement.
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Affiliation(s)
- Noam Nissan
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel HaShomer 5265601, Israel
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Ma C, Li J, Boukar MB, Yang P, Wang L, Chen L, Su L, Qu J, Chen SY, Hao Q, Lu JP. Optimized ROI size on ADC measurements of normal pancreas, pancreatic cancer and mass-forming chronic pancreatitis. Oncotarget 2017; 8:99085-99092. [PMID: 29228754 PMCID: PMC5716794 DOI: 10.18632/oncotarget.18457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives To investigate the effects of region of interest (ROI) sizes on apparent diffusion coefficient (ADC) measurements for the differentiation of normal pancreas (NP), pancreatic ductal adenocarcinoma (PDAC) and mass-forming chronic pancreatitis (MFCP). Results There were no significant differences for the mean ADCs measured by 12 different-size ROIs for MFCP, or PDAC and NP (P = 0.858–1.0). With the increase of ROI size (≥ 55 mm2), ADCs of PDAC were significantly lower than those of NP (all P < 0.05), but there was no difference of the accuracy in ADC for differentiating the two groups only at a ROI size of 214 mm2. When ROI size was above 99 mm2, ADCs of MFCP were significantly lower than those of NP (all P < 0.05). There were no significant differences for any of the mean ADCs measured by 12 different-size ROIs between PDAC and MFCP (P > 0.05). Materials and Methods Diffusion-weighted imaging (DWI) was performed on 89 participants: 64 with PDAC, 7 with MFCP, as well as 18 healthy volunteers. ADC maps were created using mono-exponential model. A homemade software was used to measure the mean ADC values of 12 concentric round ROIs (areas: 15, 46, 55, 82, 99, 121, 134, 152, 161, 189, 214, 223, and 245 mm2) for the mass of lesions and the NP tissue. Conclusions In ADC measurements, the optimized ROI size is 214 mm2 for the differentiation of PDAC and NP; ROI size of ≥ 99 mm2 is recommended to differentiate between MFCP and NP. ADC was not useful for the differentiation of PDAC and MFCP.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Mbaiaoure Barak Boukar
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Su
- School of Pharmacy, Second Military Medical University, Shanghai, China
| | - Jianxun Qu
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
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Ma C, Guo X, Liu L, Zhan Q, Li J, Zhu C, Wang L, Zhang J, Fang X, Qu J, Chen S, Shao C, Lu JP. Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma. Cancer Imaging 2017; 17:13. [PMID: 28464866 PMCID: PMC5414294 DOI: 10.1186/s40644-017-0116-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the influence of region of interest (ROI) size on tumor apparent diffusion coefficient (ADC) measurements in pancreatic cancer. METHODS The study population consisted of 64 patients with pathologically proved pancreatic ductal adenocarcinomas (PDACs), who underwent preoperative magnetic resonance imaging (MRI) examinations including diffusion-weighted imaging (DWI). The tumor ADCs were measured by two independent readers using six round ROIs with sizes ranging from 20 to 214 mm2 (9 to 97 pixels) in both the six separate measurements. The intra- and inter-observer variabilities were analyzed by using the coefficient of variance (CV), the interclass correlation coefficient (ICC) and Bland-Altman analysis. The mean ADCs measured with the 6 different-sized ROIs were compared using one-way repeated analysis of variance. The sample sizes were calculated by using 80% power and a 5% significance level to detect 10 to 25% changes in ADC measurements. RESULTS The largest ROI (ROI214) yielded the best intra-observer repeatability (CV, 6.3%; ICC, 0.93) and inter-observer reproducibility (CV, 10.1%; ICC, 0.84). The mean differences in ADC measurements ± limits of agreement between the two readers were (0.06 ± 0.47) × 10-3 mm2 for ROI20, (0.08 ± 0.46) × 10-3 mm2 for ROI46, (0.05 ± 0.37) × 10-3 mm2 for ROI82, (0.07 ± 0.42) × 10-3 mm2 for ROI115, (0.05 ± 0.43) × 10-3 mm2 for ROI152 and (-0.02 ± 0.29) × 10-3 mm2 for ROI214. CONCLUSIONS ROI size had a considerable influence on the ADC measurements of PDACs.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Xiaoyu Guo
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Qian Zhan
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
| | - Jing Zhang
- Department of Pathology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, China
| | - Xu Fang
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jianxun Qu
- GE Healthcare, MR Group, Shanghai, China
| | - Shiyue Chen
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
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Ma C, Li Y, Wang L, Wang Y, Zhang Y, Wang H, Chen S, Lu J. Intravoxel incoherent motion DWI of the pancreatic adenocarcinomas: monoexponential and biexponential apparent diffusion parameters and histopathological correlations. Cancer Imaging 2017; 17:12. [PMID: 28454564 PMCID: PMC5410078 DOI: 10.1186/s40644-017-0114-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background To investigate the associations between the diffusion parameters obtained from multiple-b-values diffusion weighted imaging (DWI) of pancreatic ductal adenocarcinoma (PDAC) and the aggressiveness and local stage prediction, and assess the values of the quantitative parameters for the discrimination of tumors from healthy pancreas. Methods Fifty-one patients with surgical pathology-proven PDAC (size, 35 ± 12 mm) and fifty-seven healthy volunteers were enrolled. Diffusion parameters including monoexponential apparent diffusion coefficient (ADCb and ADCtotal) and biexponential intravoxel incoherent motion (IVIM) parameters (ADCslow, ADCfast and f) based on 9 b-values (0 to 1000s/mm2) DWI were calculated for the lesions and the healthy pancreas. These parameters were compared by grades of differentiation, lymph node status, tumor stage and location. The diagnostic performances were calculated and compared by using the receiver operating characteristic curves (ROC) analyses. Results There was no statistically significant difference in ADCb, ADCtotal, ADCslow, ADCfast or f between PDAC stage T1/T2 and stage T3/T4 or moderately differentiated versus poorly differentiated PDAC (p = 0.060-0.941). In addition, no significant differences were observed for the quantitative parameters between tumors located in the pancreatic head versus other pancreatic regions (p = 0.203-0.954) or between tumors with and without metastatic peri-pancreatic lymph nodes (p = 0.313-0.917). ADC25-600, ADC1000, ADCtotal and ADCfast were significantly lower for PDAC compared the healthy pancreas (all p < 0.05). ROC analyses showed the area under curve for ADC20 was the largest (0.911) to distinguish PDAC from normal pancreas (cut-off value, 5.58 × 10−3mm2/s) and had the highest combined sensitivity (89.5%) and specificity (82.4%). Conclusions Multiple-b-values DWI derived monoexponential and biexponential parameters of PDAC do not exhibit significance dependence on tumor grade or tumor characteristics. ADC20 provided the best accuracy for differentiating PDAC from healthy pancreas in the study.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Yanjun Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Yang Wang
- Department of Pathology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, China
| | - Yong Zhang
- MR Group, GE Healthcare, No. 1 Huatuo Road, Shanghai, China
| | - He Wang
- MR Group, GE Healthcare, No. 1 Huatuo Road, Shanghai, China
| | - Shiyue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China.
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Heid I, Steiger K, Trajkovic-Arsic M, Settles M, Eßwein MR, Erkan M, Kleeff J, Jäger C, Friess H, Haller B, Steingötter A, Schmid RM, Schwaiger M, Rummeny EJ, Esposito I, Siveke JT, Braren RF. Co-clinical Assessment of Tumor Cellularity in Pancreatic Cancer. Clin Cancer Res 2016; 23:1461-1470. [PMID: 27663591 DOI: 10.1158/1078-0432.ccr-15-2432] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 08/14/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Tumor heterogeneity is a hallmark of pancreatic ductal adenocarcinoma (PDAC). It determines tumor biology including tumor cellularity (i.e., amount of neoplastic cells and arrangement into clusters), which is related to the proliferative capacity and differentiation and the degree of desmoplasia among others. Given the close relation of tumor differentiation with differences in progression and therapy response or, e.g., the recently reported protective role of tumor stroma, we aimed at the noninvasive detection of PDAC groups, relevant for future personalized approaches. We hypothesized that histologic differences in PDAC tissue composition are detectable by the noninvasive diffusion weighted- (DW-) MRI-derived apparent diffusion coefficient (ADC) parameter.Experimental design: PDAC cellularity was quantified histologically and correlated with the ADC parameter and survival in genetically engineered mouse models and human patients.Results: Histologic analysis showed an inverse relationship of tumor cellularity and stroma content. Low tumor cellularity correlated with a significantly prolonged mean survival time (PDAClow = 21.93 months vs. PDACmed = 12.7 months; log-rank P < 0.001; HR = 2.23; CI, 1.41-3.53). Multivariate analysis using the Cox regression method confirmed tumor cellularity as an independent prognostic marker (P = 0.034; HR = 1.73; CI, 1.04-2.89). Tumor cellularity showed a strong negative correlation with the ADC parameter in murine (r = -0.84; CI, -0.90- -0.75) and human (r = -0.79; CI, -0.90 to -0.56) PDAC and high preoperative ADC values correlated with prolonged survival (ADChigh = 41.7 months; ADClow = 14.77 months; log rank, P = 0.040) in PDAC patients.Conclusions: This study identifies high tumor cellularity as a negative prognostic factor in PDAC and supports the ADC parameter for the noninvasive identification of PDAC groups. Clin Cancer Res; 23(6); 1461-70. ©2016 AACR.
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Affiliation(s)
- Irina Heid
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Katja Steiger
- Institute of Pathology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Marija Trajkovic-Arsic
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK), partner site Essen, University Hospital Essen, Essen, Germany
| | - Marcus Settles
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Manuela R Eßwein
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Mert Erkan
- Department of Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Jörg Kleeff
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Carsten Jäger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Andreas Steingötter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Roland M Schmid
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Schwaiger
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Ernst J Rummeny
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Irene Esposito
- Institute of Pathology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
| | - Jens T Siveke
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany. .,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK), partner site Essen, University Hospital Essen, Essen, Germany
| | - Rickmer F Braren
- Institute of Radiology, Klinikum rechts der Isar, Technische Universität München, Germany.
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18
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Wegner CS, Gaustad JV, Andersen LMK, Simonsen TG, Rofstad EK. Diffusion-weighted and dynamic contrast-enhanced MRI of pancreatic adenocarcinoma xenografts: associations with tumor differentiation and collagen content. J Transl Med 2016; 14:161. [PMID: 27268062 PMCID: PMC4897888 DOI: 10.1186/s12967-016-0920-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/20/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The aggressiveness of pancreatic ductal adenocarcinoma (PDAC) is highly dependent on the level of differentiation and the composition of the stroma. In this preclinical study, we investigated the potential of diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as noninvasive methods for providing information on the differentiation and the stroma of PDACs. METHODS Xenografted tumors initiated from four PDAC cell lines (BxPC-3, Capan-2, MIAPaCa-2, and Panc-1) were included in the study. DW-MRI and DCE-MRI were carried out on a 7.05-T MR scanner, and tumor images of ADC (the apparent diffusion coefficient), K (trans) (the volume transfer constant of Gd-DOTA), and v e (the fractional distribution volume of Gd-DOTA) were produced. The level of differentiation and the amount and structure of collagen I and collagen IV were determined by examining histological preparations. RESULTS Differentiated tumors showed lower levels of collagen I and collagen IV than non-differentiated tumors. Significant correlations were found between ADC and v e, and both parameters differentiated clearly between collagen-rich non-differentiated tumors and differentiated tumors containing less collagen. CONCLUSION Differentiated PDAC xenografts show higher ADC values and higher v e values than their non-differentiated counterparts. This observation supports the application of parametric MR images as tumor biomarkers in PDAC. Patients showing low values of ADC and v e most likely have non-differentiated tumors with extensive stroma and, hence, poor prognosis.
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Affiliation(s)
- Catherine S. Wegner
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Box 4953, Nydalen, 0424 Oslo, Norway
| | - Jon-Vidar Gaustad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Box 4953, Nydalen, 0424 Oslo, Norway
| | - Lise Mari K. Andersen
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Box 4953, Nydalen, 0424 Oslo, Norway
| | - Trude G. Simonsen
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Box 4953, Nydalen, 0424 Oslo, Norway
| | - Einar K. Rofstad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Box 4953, Nydalen, 0424 Oslo, Norway
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Diffusion-weighted MR imaging of pancreatic cancer: A comparison of mono-exponential, bi-exponential and non-Gaussian kurtosis models. Eur J Radiol Open 2016; 3:79-85. [PMID: 27957518 PMCID: PMC5144112 DOI: 10.1016/j.ejro.2016.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To compare two Gaussian diffusion-weighted MRI (DWI) models including mono-exponential and bi-exponential, with the non-Gaussian kurtosis model in patients with pancreatic ductal adenocarcinoma. MATERIALS AND METHODS After written informed consent, 15 consecutive patients with pancreatic ductal adenocarcinoma underwent free-breathing DWI (1.5T, b-values: 0, 50, 150, 200, 300, 600 and 1000 s/mm2). Mean values of DWI-derived metrics ADC, D, D*, f, K and DK were calculated from multiple regions of interest in all tumours and non-tumorous parenchyma and compared. Area under the curve was determined for all metrics. RESULTS Mean ADC and DK showed significant differences between tumours and non-tumorous parenchyma (both P < 0.001). Area under the curve for ADC, D, D*, f, K, and DK were 0.77, 0.52, 0.53, 0.62, 0.42, and 0.84, respectively. CONCLUSION ADC and DK could differentiate tumours from non-tumorous parenchyma with the latter showing a higher diagnostic accuracy. Correction for kurtosis effects has the potential to increase the diagnostic accuracy of DWI in patients with pancreatic ductal adenocarcinoma.
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Kim H, Arnoletti PJ, Christein J, Heslin MJ, Posey JA, Pednekar A, Mark Beasley T, Morgan DE. Pancreatic adenocarcinoma: a pilot study of quantitative perfusion and diffusion-weighted breath-hold magnetic resonance imaging. ACTA ACUST UNITED AC 2016; 39:744-52. [PMID: 24549880 DOI: 10.1007/s00261-014-0107-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To confirm the feasibility of breath-hold DCE-MRI and DWI at 3T to obtain the intra-abdominal quantitative physiologic parameters, K(trans), k ep, and ADC, in patients with untreated pancreatic ductal adenocarcinomas. METHODS Diffusion-weighted single-shot echo-planar imaging (DW-SS-EPI) and dynamic contrast-enhanced (DCE) MRI were used for 16 patients with newly diagnosed biopsy-proven pancreatic ductal adenocarcinomas. K(trans), k ep, and apparent diffusion coefficient (ADC) values of pancreatic tumors, non-tumor adjacent pancreatic parenchyma (NAP), liver metastases, and normal liver tissues were quantitated and statistically compared. RESULTS Fourteen patients were able to adequately hold their breath for DCE-MRI, and 15 patients for DW-SS-EPI. Four patients had liver metastases within the 6 cm of Z axis coverage centered on the pancreatic primary tumors. K(trans) values (10(-3) min(-1)) of primary pancreatic tumors, NAP, liver metastases, and normal liver tissues were 7.3 ± 4.2 (mean ± SD), 25.8 ± 14.9, 8.1 ± 5.9, and 45.1 ± 15.6, respectively, k ep values (10(-2) min(-1)) were 3.0 ± 0.9, 7.4 ± 3.1, 5.2 ± 2.0, and 12.1 ± 2.8, respectively, and ADC values (10(-3) mm(2)/s) were 1.3 ± 0.2, 1.6 ± 0.3, 1.1 ± 0.1, and 1.3 ± 0.1, respectively. K(trans), k ep, and ADC values of primary pancreatic tumors were significantly lower than those of NAP (p < 0.05), while K(trans) and k ep values of liver metastases were significantly lower than those of normal liver tissues (p < 0.05). CONCLUSIONS 3T breath-hold quantitative physiologic MRI is a feasible technique that can be applied to a majority of patients with pancreatic adenocarcinomas.
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Affiliation(s)
- Hyunki Kim
- Departments of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294-0019, USA,
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Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR Imaging in Abdominal Malignancies. Magn Reson Imaging Clin N Am 2016; 24:157-186. [PMID: 26613880 PMCID: PMC4974463 DOI: 10.1016/j.mric.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Modern MR imaging protocols can yield both anatomic and functional information for the assessment of hepatobiliary and pancreatic malignancies. Diffusion-weighted imaging is fully integrated into state-of-the-art protocols for tumor detection, characterization, and therapy monitoring. Hepatobiliary contrast agents have gained ground in the evaluation of focal liver lesions during the last years. Perfusion MR imaging is expected to have a central role for monitoring therapy in body tumors treated with antivascular drugs. Approaches such as Magnetic resonance (MR) elastography and (1)H-MR spectroscopy are still confined to research centers, but with the potential to grow in a short time frame.
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Affiliation(s)
- Antonio Luna
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain; Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Shivani Pahwa
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lidia Alcalá-Mata
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain
| | - Katherine L Wright
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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22
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Hayano K, Miura F, Wada K, Suzuki K, Takeshita K, Amano H, Toyota N, Sano K, Asano T. Diffusion-weighted MR imaging of pancreatic cancer and inflammation: Prognostic significance of pancreatic inflammation in pancreatic cancer patients. Pancreatology 2016; 16:121-126. [PMID: 26596539 DOI: 10.1016/j.pan.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic cancer often accompanies chronic obstructive pancreatitis (COP) due to obstruction of the main pancreatic duct, and the inflammatory environment may enhance cancer progression. The purpose of this study is to evaluate COP using the apparent diffusion coefficient (ADC) value measured by diffusion-weighted MR imaging (DWI), and to assess its prognostic significance in pancreatic cancer. METHODS Twenty-eight patients (16 men, 12 women; mean age 67.1 years) with pancreatic cancers who underwent DWI followed by curative surgery were evaluated. The ADC value of pancreatic parenchyma upstream to the tumor (upstream pancreas) was measured and compared with the upstream pancreatic duct dilatation to assess whether DWI could reflect COP. The ADC values of tumor and upstream portion were compared with overall survival (OS) using Cox regression and Kaplan-Meier analysis. RESULTS The ADC value of upstream pancreas was significantly lower in patients with greater dilated pancreatic duct than those with less (P = 0.03). In univariate Cox regression analysis, the ADC value of upstream pancreas showed a significant association with OS (P = 0.01), but that of tumor did not (P = 0.06). In Kaplan-Meier analysis, patients with lower ADC value of upstream pancreas (<1.36 × 10(-3) mm(2)/s) were significantly associated with poor OS (P = 0.0006). In multivariate analysis, the ADC value of upstream pancreas was identified as an independent prognostic factor (P = 0.01; hazards ratio, 0.05; 95% CI, 0.004-0.59). CONCLUSIONS The ADC value of upstream pancreas was an independent prognostic factor for OS in pancreatic cancer patients. Inflammatory environment may play an important role in pancreatic cancer progression.
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Affiliation(s)
- Koichi Hayano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazufumi Suzuki
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koji Takeshita
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takehide Asano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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The Correlation Between Diffusion-Weighted Imaging at 3.0-T Magnetic Resonance Imaging and Histopathology for Pancreatic Ductal Adenocarcinoma. J Comput Assist Tomogr 2015; 39:697-701. [PMID: 26176427 DOI: 10.1097/rct.0000000000000274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this study was to discuss the correlation between diffusion-weighted imaging (DWI) at 3.0-T magnetic resonance and histopathology for pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS Twenty-eight patients with histopathologically proven PDA were included in this study after 108 cases of suspected pancreatic tumors had been performed with DWI. The sequences of DWI included respiratory-triggered DWI and breath-hold DWI, which were performed with 2 b values (0 and 500 s/mm; 0 and 1000 s/mm), respectively. According to magnetic resonance images, wax blocks and slices were selected and stained with hematoxylin-eosin for anti-vascular endothelial growth factor (VEGF), anti-CD34, and anti-Ki-67 (Mib-1). The relationship between tumor apparent diffusion coefficient (ADC) and tumor fibrosis, as well as the expression of tumor VEGF, Ki-67, and multivessel density (MVD), were studied. RESULTS The ADC values of PDA of different grades of differentiation and fibrosis grade did not show statistically significant difference. The ADC values of PDA did not show the statistically significant correlation with the grades of differentiation, fibrosis grade, Ki-67 expression, and expression of VEGF and MVD. CONCLUSIONS The ADC of PDA cannot be used to reflect grades of differentiation, degree of tumor fibrosis, the expression of VEGF, the expression of Ki-67, and the tumor MVD.
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Liu L, Ma C, Li J, Wang L, Chen LG, Zhang Y, Chen SY, Lu JP. Comparison of the Diagnostic Performances of Three Techniques of ROI Placement for ADC Measurements in Pancreatic Adenocarcinoma. Acad Radiol 2015; 22:1385-92. [PMID: 26292914 DOI: 10.1016/j.acra.2015.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/16/2015] [Accepted: 06/16/2015] [Indexed: 01/27/2023]
Abstract
RATIONALE AND OBJECTIVES To prospectively investigate and compare three techniques of region of interest (ROI) placement for apparent diffusion coefficient (ADC) measurements in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Twenty-one patients with surgical pathology-proven PDAC and 18 healthy volunteers were included. Respiratory-triggered single-shot echo-planar diffusion-weighted imaging (b values = 0, 600 s/mm(2)) was used to calculate the ADC maps across all participants. Three readers independently measured the ADCs according to three ROI methods: whole-volume, single-slice, and small solid samples of tumor. Mean ADCs for the healthy pancreas were calculated using three measurements from pancreatic head to tail, and ADCs of distal pancreas to the tumor were also measured. The interobserver variability for the three techniques was measured using the interclass correlation coefficient. The diagnostic performances were calculated and compared using the receiver operating characteristic curves (ROC). RESULTS All the ADCs measured from the three ROI placements on PDAC were significantly lower than that from the normal pancreas. ADCs of solid tumor samples were significantly lower than that measured from whole volume or single slice (both P < .001). Only the ADCs measured from the solid sample ROI placements on tumor were observed significantly lower than the ADC of distal pancreatic parenchyma (P = .005). Areas under the ROC for the identification of PDAC, based on small solid samples, single-slice and whole-volume ROIs, respectively, were 0.939, 0.791, and 0.735. CONCLUSIONS ADC based on the small solid samples of tumor provided the highest diagnostic performance in assessing PDAC and was more accurate than ADCs measured from single-slice or whole-volume ROI.
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Affiliation(s)
- Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Lu-guang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Yong Zhang
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Jian-ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China.
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De Robertis R, Tinazzi Martini P, Demozzi E, Dal Corso F, Bassi C, Pederzoli P, D’Onofrio M. Diffusion-weighted imaging of pancreatic cancer. World J Radiol 2015; 7:319-328. [PMID: 26516428 PMCID: PMC4620112 DOI: 10.4329/wjr.v7.i10.319] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma (PDAC). Diffusion-weighted imaging (DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues (the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion (IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation (perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.
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Abstract
PURPOSE To identify the MRI sequences producing the greatest pancreatic adenocarcinoma conspicuity and to assess correlations linking MRI signal intensity and apparent diffusion coefficient to histopathological findings. METHODS We retrospectively included 22 patients with pancreatic adenocarcinoma who underwent MRI (1.5 or 3 T) before surgical resection. Fat-suppressed (FS) T1- and T2-weighted sequences; 3D FS dynamic T1-weighted gadolinium-enhanced gradient-echo (GRE) imaging at the arterial, portal, and delayed phases; and diffusion-weighted imaging (DWI) with b values of 600-800 s/mm(2) were reviewed. On each sequence, we assessed tumor conspicuity both qualitatively (3-point scale) and quantitatively (tumor-to-proximal and -distal pancreas contrast ratios), and we performed paired Wilcoxon tests to compare these data across sequences. We evaluated correlations between histopathological characteristics and MRI features. RESULTS 21/22 (95%) tumors were hypointense by 3D FS T1 GRE arterial phase imaging, which produced the greatest tumor conspicuity (p ≤ 0.02). By DWI, 5/20 (25%) of tumors were isointense. The correlation between size by histology and MRI was strongest with DWI. A progressive enhancement pattern was associated with extensive and dense fibrous stroma (p ≤ 0.03). CONCLUSIONS 3D FS T1 GRE arterial phase imaging produces greater pancreatic adenocarcinoma conspicuity compared to DWI but underestimates tumor size. DWI provides the best size evaluation but fails to delineate the tumor in one-fourth of cases.
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Ma C, Liu L, Li J, Wang L, Chen LG, Zhang Y, Chen SY, Lu JP. Apparent diffusion coefficient (ADC) measurements in pancreatic adenocarcinoma: A preliminary study of the effect of region of interest on ADC values and interobserver variability. J Magn Reson Imaging 2015; 43:407-13. [PMID: 26182908 DOI: 10.1002/jmri.25007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the influence of region of interest (ROI) on tumor apparent diffusion coefficient (ADC) measurements and interobserver variability in pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Twenty-two patients recruited with pathology-proven PDAC underwent diffusion-weighted imaging (DWI, 3.0T) prior to the surgical resection. Two independent readers measured tumor ADCs according to three ROI methods: whole-volume, single-slice, and small solid sample of tumor. Minimum and mean ADCs were obtained. The interobserver variability for each of the three methods was analyzed using interclass correlation coefficient (ICC) and Bland-Altman analysis. The minimum and mean ADCs among the ROI methods were compared using nonparametric tests. RESULTS The single-slice ROI method showed the best reproducibility in the minimum ADC measurements (mean difference ± limits of agreement between two readers were 0.025 ± 0.25 × 10(-3) mm2 /s; ICC, 0.92) among the three ROI methods. For the solid tumor sample ROI, both minimum ADC and mean ADC measurements reproducibility were the worst, with limits of agreement up to ±0.50 × 10(-3) mm2 /s and ±0.32 × 10(-3) mm2 /s, respectively (ICCs, 0.41/0.58). Both the minimum and mean ADCs demonstrated significant differences among the three ROI methods (both P < 0.001). The post-hoc analyses results showed no significant difference with regard to the mean ADCs between whole-volume and single-slice ROI methods (P = 0.14). CONCLUSION The ROI method had a considerable influence on both the minimum and mean ADC values and the interobserver variability in PDAC. The worst interobserver variability was observed for both the minimum and mean ADCs derived from small solid-sample ROI.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Lu-Guang Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Yong Zhang
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
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Cha MJ, Yoon YC. Clinical relevance of the apparent diffusion coefficient value of metastatic bone tumours on diffusion-weighted MRI images: differences according to the types of primary tumour, the affected bones, and clinical factors. Clin Radiol 2015; 70:1116-21. [PMID: 26145186 DOI: 10.1016/j.crad.2015.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/13/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022]
Abstract
AIM To evaluate whether the apparent diffusion coefficient (ADC) of metastatic bone tumours on diffusion-weighted magnetic resonance imaging (MRI) images differs according to the type of primary cancer, the affected bone, and clinical factors. MATERIALS AND METHODS For this retrospective study, two radiologists reviewed MRI images, including ADC maps, of 67 patients (M:F=38:29; median age, 48 years) who were diagnosed with bone metastasis by means of histological or clinical confirmation. The primary tumours included 29 lung adenocarcinomas, 15 invasive ductal adenocarcinomas of the breast, 13 hepatocellular carcinomas, six prostatic carcinomas, and four renal cell carcinomas. ADC values of the metastatic tumour were compared according to the type of primary malignancy, the affected bone, and the age and sex of the patient using Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni correction. In addition, pre-contrast CT images were available in 38 of 67 patients; a subanalysis of the CT radiodensity and ADC values were performed with Spearman correlation. RESULTS The mean, standard deviation, and minimum and maximum values of the ADC of metastatic bone tumours did not differ significantly according to type of primary malignancy, the affected bone, or clinical variables (p>0.1). The ADC value was not significantly correlated with CT radiodensity (p=0.24). Intra- and interobserver agreements for the mean ADC values were excellent (intra-observer: p=0.98; interobserver: p=0.98). CONCLUSIONS Assessment of the ADC value of metastatic bone tumours is not reliable for differentiation of the type of primary cancer.
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Affiliation(s)
- M J Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y C Yoon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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De Robertis R, Tinazzi Martini P, Demozzi E, Puntel G, Ortolani S, Cingarlini S, Ruzzenente A, Guglielmi A, Tortora G, Bassi C, Pederzoli P, D’Onofrio M. Prognostication and response assessment in liver and pancreatic tumors: The new imaging. World J Gastroenterol 2015; 21:6794-6808. [PMID: 26078555 PMCID: PMC4462719 DOI: 10.3748/wjg.v21.i22.6794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.
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Hong BZ, Li XF, Lin JQ. Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging. World J Gastroenterol 2015; 21:6374-6380. [PMID: 26034373 PMCID: PMC4445115 DOI: 10.3748/wjg.v21.i20.6374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/26/2014] [Accepted: 01/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnostic ability of single-shot echo-planar imaging (EPI) diffusion-weighted imaging (DWI) to differentiate between malignant and benign pancreatic lesions.
METHODS: A computerized search was performed on PubMed, MEDLINE and EMBASE up to August 2014. Nine studies (10 sets of data) with a total of 304 malignant pancreatic lesions and 188 benign pancreatic lesions were included. The characteristics of each study included the study name, year of publication, magnetic resonance modalities used, patient population, strength of field, pulse time, repetition time, echo time (TE), maximum b factor, mean age, mean body weight, fat suppression, number of benign and malignant lesions, and true positive, true negative, false positive and false negative results. All analyses were performed using Meta-DiSc and Stata 11.0.
RESULTS: The pooled sensitivity and specificity of single-shot EPI DWI were 0.83 (95%CI: 0.79-0.87) and 0.77 (95%CI: 0.70-0.83), respectively. The positive likelihood ratio and negative likelihood ratio were 5.09 (95%CI: 2.19-11.84) and 0.23 (95%CI: 0.15-0.36), respectively. The P value for the χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.89 and 0.82, respectively. Publication bias was not present (t = 0.58, P = 0.58). Meta-regression analysis indicated that fat suppression, mean age, TE, and maximum b factor were not sources of heterogeneity (all P > 0.05).
CONCLUSION: Single-shot EPI DWI is useful to differentiate between malignant and benign pancreatic lesions. Lesion size ≥ 2 cm is the limit for the diagnosis of early lesions.
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Abstract
Diffusion-weighted imaging (DWI) has become a routine component of clinical MR imaging. Its unique soft tissue contrast mechanism exploits differences in the motion of water molecules in vivo at a biologically meaningful scale. The clinical potential of DWI in lesion detection, characterization, and response assessment has been explored. This review briefly covers basic principles of DWI and introduces advances, specifically for abdominopelvic organs.
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Affiliation(s)
- Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; St Eloi Hospital, CHU Montpellier, Montpellier, France
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Dynamic contrast-enhanced magnetic resonance imaging for pancreatic ductal adenocarcinoma at 3.0-T magnetic resonance: correlation with histopathology. J Comput Assist Tomogr 2015; 39:13-8. [PMID: 25340589 DOI: 10.1097/rct.0000000000000171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to discuss the correlation of quantitative dynamic contrast-enhanced magnetic resonance imaging (QDCE-MRI) at 3.0-T magnetic resonance and histopathology for pancreatic ductal adenocarcinoma (PDA). METHODS Twenty-three patients with histopathologically proven PDA were included in this study after 75 cases of suspected pancreatic tumors had been performed by QDCE-MRI. The quantitative kinetic parameters analyzed by 2-compartment and 3-compartment models were calculated automatically, which included the volume transfer constant of the contrast agent, the rate constant (Kep), the volume as a percentage of the extravascular extracellular leakage space, the time of arrival of contrast agent, the time of peaking of contrast agent, the maximum slope of signal intensity ascent, and the contrast enhancement ratio. According to magnetic resonance images, tissue section were selected and stained for evaluating tumor differentiation, tumor fibrosis, tumor microvessel density, the expression of tumor vascular endothelial growth factor (VEGF) and Ki67. Subsequently, the relationship between the parameters of QDCE-MRI and histopathology of PDA was analyzed. RESULTS The tumor Kep and extravascular extracellular leakage space showed a statistically significant correlation with tumor fibrosis; the tumor volume transfer constant of the contrast agent 2-compartment showed a statistically significant correlation with the expressions of tumor VEGF; and the tumor Kep, maximum slope of signal intensity ascent, and contrast enhancement ratio showed a statistically significant correlation with the expression of tumor Ki67. CONCLUSIONS The parameters of QDCE-MRI of PDA can be used to evaluate the degrees of tumor fibrosis and the expressions of VEGF and Ki67.
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Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, Vilgrain V, Hoeffel C, Kanematsu M, Soyer P. Diffusion-weighted MR Imaging of the Pancreas: Current Status and Recommendations. Radiology 2015; 274:45-63. [DOI: 10.1148/radiol.14130778] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
In this article, functional magnetic resonance (MR) imaging techniques in the abdomen are discussed. Diffusion-weighted imaging (DWI) increases the confidence in detecting and characterizing focal hepatic lesions. The potential uses of DWI in kidneys, adrenal glands, bowel, and pancreas are outlined. Studies have shown potential use of quantitative dynamic contrast-enhanced MR imaging parameters, such as K(trans), in predicting outcomes in cancer therapy. MR elastography is considered to be a useful tool in staging liver fibrosis. A major issue with all functional MR imaging techniques is the lack of standardization of the protocol.
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Affiliation(s)
- Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202, USA.
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Ma C, Liu L, Li YJ, Chen LG, Pan CS, Zhang Y, Wang H, Chen SY, Lu JP. Intravoxel incoherent motion MRI of the healthy pancreas: Monoexponential and biexponential apparent diffusion parameters of the normal head, body and tail. J Magn Reson Imaging 2014; 41:1236-41. [PMID: 24979657 DOI: 10.1002/jmri.24684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/10/2014] [Indexed: 02/01/2023] Open
Affiliation(s)
- Chao Ma
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Li Liu
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Yan-jun Li
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
- Department of Medical Imaging; Jinling Hospital, Clinical School of Medical College, Nanjing University; Nanjing China
| | - Lu-guang Chen
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Chun-shu Pan
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | | | - He Wang
- GE Healthcare, MR Group; Shanghai China
| | - Shi-yue Chen
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Jian-ping Lu
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
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Ma C, Wang J, Li YJ, Pan CS, Zhang Y, Wang H, Chen SY, Lu JP. Comparisons of Image Quality and ADCs in Breath-Hold, Respiratory-Triggered and Free-Breathing DWI of Pancreas at 3-T. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojrad.2014.44037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fukukura Y, Takumi K, Higashi M, Shinchi H, Kamimura K, Yoneyama T, Tateyama A. Contrast-enhanced CT and diffusion-weighted MR imaging: performance as a prognostic factor in patients with pancreatic ductal adenocarcinoma. Eur J Radiol 2013; 83:612-9. [PMID: 24418286 DOI: 10.1016/j.ejrad.2013.12.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether contrast enhancement of CT and apparent diffusion coefficient on diffusion-weighted MR imaging are important parameters that can predict outcomes for patients with pancreatic ductal adenocarcinoma. MATERIALS AND METHODS Ninety-two patients with histologically confirmed pancreatic ductal adenocarcinoma who underwent quadriphasic CT (including unenhanced, pancreatic parenchymal, portal venous and delayed phases) and fat-suppressed single-shot echo-planar diffusion-weighted MR imaging at 3.0 T were retrospectively analyzed to investigate prognostic factors. Overall survival curves were drawn using the Kaplan-Meier method. Effects on survival of variables including age, sex, tumor location, tumor size, TNM stage, carbohydrate antigen 19-9, carcinoembryonic antigen, treatment, tumor contrast enhancement and apparent diffusion coefficient values were analyzed in univariate analysis using the log-rank test. Variables were analyzed in multivariate analyses using the Cox proportional hazards regression model. RESULTS Median survival for the entire patient population was 18.2 months. Higher contrast enhancement during all phases was associated with significantly longer overall survival (P<0.001 for all phases). The difference in overall survival between groups divided by median apparent diffusion coefficient value was not significant (P=0.672). TNM stage (P=0.026) and tumor contrast enhancement on CT (P=0.027) were significantly related to survival in multivariate analysis. CONCLUSIONS Poor enhancement of pancreatic adenocarcinomas on enhanced CT is associated with reduced patient survival.
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Affiliation(s)
- Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
| | - Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Michiyo Higashi
- Department of Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Hiroyuki Shinchi
- Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Kiyohisa Kamimura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Tomohide Yoneyama
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
| | - Akihiro Tateyama
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan
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Ma C, Li YJ, Pan CS, Wang H, Wang J, Chen SY, Lu JP. High resolution diffusion weighted magnetic resonance imaging of the pancreas using reduced field of view single-shot echo-planar imaging at 3 T. Magn Reson Imaging 2013; 32:125-31. [PMID: 24231348 DOI: 10.1016/j.mri.2013.10.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/01/2013] [Accepted: 10/11/2013] [Indexed: 12/20/2022]
Abstract
Diffusion weighted magnetic resonance imaging (DWI) has been mostly acquired using single-shot echo-planar imaging (ss EPI) to minimize motion induced artifacts. The spatial resolution, however, is inherently limited in ss EPI especially for abdominal imaging, even with the advances in parallel imaging. A novel method of reduced Field of View ss EPI (rFOV ss EPI) has achieved high resolution DWI in human carotid artery, spinal cord with reduced blurring and higher spatial resolution than conventional ss EPI, but it has not been used to pancreas imaging. In the work, comparisons between the full FOV ss-DW EPI and rFOV ss-DW EPI in image qualities and ADC values of pancreatic tumors and normal pancreatic tissues were performed to demonstrate the feasibility of pancreatic high resolution rFOV DWI. There were no significant differences in the mean ADC values between full FOV DWI and rFOV DWI for the 17 subjects using b=600s/mm(2) (P=0.962). However, subjective scores of image quality was significantly higher at rFOV ss DWI (P=0.008 and 0.000 for b-value=0s/mm(2) and 600s/mm(2) respectively). The spatial resolution of DWI for pancreas was increased by a factor of over 2.0 (from almost 3.0mm/pixel to 1.25mm/pixel) using rFOV ss EPI technique. Reduced FOV ss EPI can provide good DW images and is promising to benefit applications for pancreatic diseases.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Yan-jun Li
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Chun-shu Pan
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - He Wang
- MR Group, GE Healthcare, Shanghai, China
| | - Jian Wang
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Shi-yue Chen
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Jian-ping Lu
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
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