MR imaging for predicting the recurrence of pancreatic carcinoma after surgical resection

MRI-Based Tumor Necrosis Depiction in Pancreatic Ductal Adenocarcinoma: Can It Predict Tumor Aggressiveness?

The purpose of this study was to investigate whether tumor necrosis depicted on contrast-enhanced abdominal MRI can predict tumor aggressiveness in pancreatic ductal adenocarcinoma (PDAC). In this retrospective analysis, we included 71 patients with pathology-proven PDAC who underwent contrast-enhanced MRI from 2006 to 2020. Assessment for the presence/absence of imaging detected necrosis was performed on T2-weighted and contrast-enhanced T1-weighted images. Primary tumor characteristics, regional lymphadenopathy, metastases, stage, and overall survival were analyzed. Fisher's exact and Mann-Whitney U tests were used for statistical analysis. Of the 72 primary tumors, necrosis was identified on MRI in 58.3% (42/72). Necrotic PDACs were larger (44.6 vs. 34.5 mm, p = 0.0016), had higher rates of regional lymphadenopathy (69.0% vs. 26.7%, p = 0.0007), and more frequent metastases (78.6% vs. 40.0%, p = 0.0010) than those without MRI-evident necrosis. A non-statistically significant reduction in median overall survival was observed in patients with versus without MRI-evident necrosis (15.8 vs. 38.0 months, p = 0.23). PDAC tumor necrosis depicted on MRI was associated with larger tumors and higher frequency of regional lymphadenopathy and metastases.

The Time to and Type of Pancreatic Cancer Recurrence after Surgical Resection: Is Prediction Possible?

RATIONALE AND OBJECTIVES

To evaluate factors predicting pancreatic cancer recurrence, and to determine the most common appearance of tumor relapse.

MATERIALS AND METHODS

Ninety patients with recurrent pancreatic cancer were retrospectively included in the study. 74.4% had pancreatic head tumors (group 1) and 25.6% pancreatic body and/or tail tumor (group 2). The tumor localization, operative technique, TNM stage, the R-status, tumor grade, lymphovascular, and perineural invasion were recorded. Location of local tumor recurrence, lymph node recurrence, or organ metastases were analyzed on the basis of follow-up CT imaging.

RESULTS

Mean recurrence time was 17.4 ± 13.2 months. The most common recurrence type was local recurrence (84.4%), followed by lymph node (15.5%), liver (14.4%), and lung metastasis (6.7%). The predominant site of local recurrence in pancreatic head tumors was close to superior mesenteric artery, common hepatic artery, and/or celiac artery (57.4%), followed by area defined by portal vein, inferior vena cava, CA or superior mesenteric artery (31.2%). Patients with pancreatic body and/or tail carcinoma had higher incidence (p = 0.003) of metastatic disease comparing to pancreatic head tumors, while resection margin was the most common type of local tumor recurrence, seen in 46.7% cases versus 8.2% of patients with pancreatic head tumors (p < 0.001).

CONCLUSION

The most common recurrence type in patients with resected pancreatic carcinoma was local recurrence along cardinal arteries. The localization of primary tumor influences the type of tumor relapse and site of local recurrence.

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part I): Anatomy, imaging of the extrapancreatic nerve

Pancreatic carcinoma is an extremely high-grade malignant tumor with fast development and high mortality. The incidence of pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the main characteristics and important prognostic factors in pancreatic carcinoma, especially invasion into the nervous system; pancreatic nerve innervation includes the intrapancreatic and extrapancreatic nerves. A strong grasp of pancreatic nerve innervation may contribute to our understanding of pancreatic pain modalities and the metastatic routes for pancreatic carcinomas. Computed tomography (CT) and magnetic resonance imaging (MRI) are helpful techniques for depicting the anatomy of extrapancreatic nerve innervation. The purpose of the present work is to show and describe the anatomy of the extrapancreatic neural plexus and to elucidate its characteristics using CT and MRI, drawing on our own previous work and the research findings of others.

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part II): Imaging of pancreatic carcinoma nerve invasion

Computed tomography (CT) and magnetic resonance imaging (MRI) are excellent modalities which have the ability to detect, depict and stage the nerve invasion associated with pancreatic carcinoma. The aim of this article is to review the CT and MR patterns of pancreatic carcinoma invading the extrapancreatic neural plexus and thus provide useful information which could help the choice of treatment methods. Pancreatic carcinoma is a common malignant neoplasm with a high mortality rate. There are many factors influencing the prognosis and treatment options for those patients suffering from pancreatic carcinoma, such as lymphatic metastasis, adjacent organs or tissue invasion, etc. Among these factors, extrapancreatic neural plexus invasion is recognized as an important factor when considering the management of the patients.

Imaging evaluation of therapeutic response in patients with pancreatic cancer: recent advances

Chemoradiotherapy is the primary choice of non-surgical treatment of advanced pancreatic cancer, and diagnostic imaging plays an important role in objectively assessing early therapeutic response. This article systematically reviews the criteria for evaluation of therapeutic response in solid tumors and their application in pancreatic cancer, highlighting some key contents in imaging evaluation of therapeutic response in patients with pancreatic cancer.