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Liu W, Xie T, Chen L, Tang W, Zhang Z, Wang Y, Deng W, Xie X, Zhou Z. Dual-layer spectral detector CT: A noninvasive preoperative tool for predicting histopathological differentiation in pancreatic ductal adenocarcinoma. Eur J Radiol 2024; 173:111327. [PMID: 38330535 DOI: 10.1016/j.ejrad.2024.111327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To predict histopathological differentiation grades in patients with pancreatic ductal adenocarcinoma (PDAC) before surgery with quantitative and qualitative variables obtained from dual-layer spectral detector CT (DLCT). METHODS Totally 128 patients with histopathologically confirmed PDAC and preoperative DLCT were retrospectively enrolled and categorized into the low-grade (LG) (well and moderately differentiated, n = 82) and high-grade (HG) (poorly differentiated, n = 46) subgroups. Both conventional and spectral variables for PDAC were measured. The ratio of iodine concentration (IC) values in arterial phase(AP) and venous phase (VP) was defined as iodine enhancement fraction_AP/VP (IEF_AP/VP). Necrosis was visually assessed on both conventional CT images (necrosis_con) and virtual mono-energetic images (VMIs) at 40 keV (necrosis_40keV). Forward stepwise logistic regression method was conducted to perform univariable and multivariable analysis. Receiver operating characteristic (ROC) curves and the DeLong method were used to evaluate and compare the efficiencies of variables in predicting tumor grade. RESULTS Necrosis_con (odds ratio [OR] = 2.84, 95% confidence interval [CI]: 1.13-7.13; p < 0.001) was an independent predictor among conventional variables, and necrosis_40keV (OR = 5.82, 95% CI: 1.98-17.11; p = 0.001) and IEF_AP/VP (OR = 1.12, 95% CI:1.07-1.17; p < 0.001) were independent predictors among spectral variables for distinguishing LG PDAC from HG PDAC. IEF_AP/VP (AUC = 0.754, p = 0.016) and combination model (AUC = 0.812, p < 0.001) had better predictive performances than necrosis_con (AUC = 0.580). The combination model yielded the highest sensitivity (72%) and accuracy (79%), while IEF_AP/VP exhibited the highest specificity (89%). CONCLUSION Variables derived from DLCT have the potential to preoperatively evaluate PDAC tumor grade. Furthermore, spectral variables and their combination exhibited superior predictive performances than conventional CT variables.
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Affiliation(s)
- Wei Liu
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tiansong Xie
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Lei Chen
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zehua Zhang
- Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai 200072, China
| | - Weiwei Deng
- Clinical and Technical Support, Philips Healthcare, Shanghai 200072, China
| | - Xuebin Xie
- Department of Radiology, Kiang Wu Hospital, Macao 999078, China.
| | - Zhengrong Zhou
- Department of Radiology, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Department of Radiology, Minhang Branch, Fudan University Shanghai Cancer Center, Shanghai 201100, China.
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Choi MH, Yoon SB, Lee YJ, Jung ES, Pak S, Han D, Nickel D. Rim enhancement of pancreatic ductal adenocarcinoma: investigating the relationship with DCE-MRI-based radiomics and next-generation sequencing. Front Oncol 2024; 14:1304187. [PMID: 38525415 PMCID: PMC10959187 DOI: 10.3389/fonc.2024.1304187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To identify the clinical and genetic variables associated with rim enhancement of pancreatic ductal adenocarcinoma (PDAC) and to develop a dynamic contrast-enhanced (DCE) MRI-based radiomics model for predicting the genetic status from next-generation sequencing (NGS). Materials and methods Patients with PDAC, who underwent pretreatment pancreatic DCE-MRI between November 2019 and July 2021, were eligible in this prospective study. Two radiologists evaluated presence of rim enhancement in PDAC, a known radiological prognostic indicator, on DCE MRI. NGS was conducted for the tissue from the lesion. The Mann-Whitney U and Chi-square tests were employed to identify clinical and genetic variables associated with rim enhancement in PDAC. For continuous variables predicting rim enhancement, the cutoff value was set based on the Youden's index from the receiver operating characteristic (ROC) curve. Radiomics features were extracted from a volume-of-interest of PDAC on four DCE maps (Ktrans, Kep, Ve, and iAUC). A random forest (RF) model was constructed using 10 selected radiomics features from a pool of 392 original features. This model aimed to predict the status of significant NGS variables associated with rim enhancement. The performance of the model was validated using test set. Results A total of 55 patients (32 men; median age 71 years) were randomly assigned to the training (n = 41) and test (n = 14) sets. In the training set, KRAS, TP53, CDKN2A, and SMAD4 mutation rates were 92.3%, 61.8%, 14.5%, and 9.1%, respectively. Tumor size and KRAS variant allele frequency (VAF) differed between rim-enhancing (n = 12) and nonrim-enhancing (n = 29) PDACs with a cutoff of 17.22%. The RF model's average AUC from 10-fold cross-validation for predicting KRAS VAF status was 0.698. In the test set comprising 6 tumors with low KRAS VAF and 8 with high KRAS VAF, the RF model's AUC reached 1.000, achieving a sensitivity of 75.0%, specificity of 100% and accuracy of 87.5%. Conclusion Rim enhancement of PDAC is associated with KRAS VAF derived from NGS-based genetic information. For predicting the KRAS VAF status in PDAC, a radiomics model based on DCE maps showed promising results.
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Affiliation(s)
- Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Bae Yoon
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seongyong Pak
- Research Collaboration, Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dongyeob Han
- Research Collaboration, Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
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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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Rho S, Martin S, Nigogosyan Z, Kushnir V, Mintz AJ, Hu ZI. Pancreatic tail cancer in the setting of pancreatitis with a review of the literature: A case report. Clin Case Rep 2023; 11:e8023. [PMID: 37830064 PMCID: PMC10565090 DOI: 10.1002/ccr3.8023] [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: 06/14/2023] [Revised: 08/26/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
Environmental risk factors for pancreatic cancer include acute and chronic pancreatitis, obesity, and tobacco use. Differentiating a pancreatic neoplasm in a patient with pancreatitis can be challenging due to their similar presentations. A 57-year-old African American man with a history of congestive heart failure, pancreatitis, and incomplete pancreas divisum presented with an epigastric abdominal pain that radiated to his back. Imaging showed necrotizing pancreatitis, a developing splenic infarct, and a mass at the pancreas tail. The patient was discharged with pain medications and was recommended follow-up imaging after resolution of his pancreatitis. He was readmitted to the emergency department 2 weeks later with recurrent acute abdominal pain. Computed tomography scan of abdomen and pelvis followed by magnetic resonance imaging and endoscopic ultrasound revealed an infiltrative pancreatic tail mass. Biopsy of the mass confirmed a locally advanced pancreatic tail adenocarcinoma. Chronic pancreatitis is associated with pancreatic cancer. Practitioners should be aware of the co-existence of chronic pancreatitis and pancreatic cancer, and the initial steps to evaluate a malignancy in chronic pancreatitis.
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Affiliation(s)
- Shinji Rho
- School of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Sooyoung Martin
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Zack Nigogosyan
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Vladimir Kushnir
- Department of GastroenterologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Aaron J. Mintz
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Zishuo Ian Hu
- Department of Medicine, Division of Oncology, Section of Medical OncologyWashington University School of MedicineSt. LouisMissouriUSA
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Wu C, Wang N, Gaddam S, Wang L, Han H, Sung K, Christodoulou AG, Xie Y, Pandol S, Li D. Retrospective quantification of clinical abdominal DCE-MRI using pharmacokinetics-informed deep learning: a proof-of-concept study. FRONTIERS IN RADIOLOGY 2023; 3:1168901. [PMID: 37731600 PMCID: PMC10507354 DOI: 10.3389/fradi.2023.1168901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
Introduction Dynamic contrast-enhanced (DCE) MRI has important clinical value for early detection, accurate staging, and therapeutic monitoring of cancers. However, conventional multi-phasic abdominal DCE-MRI has limited temporal resolution and provides qualitative or semi-quantitative assessments of tissue vascularity. In this study, the feasibility of retrospectively quantifying multi-phasic abdominal DCE-MRI by using pharmacokinetics-informed deep learning to improve temporal resolution was investigated. Method Forty-five subjects consisting of healthy controls, pancreatic ductal adenocarcinoma (PDAC), and chronic pancreatitis (CP) were imaged with a 2-s temporal-resolution quantitative DCE sequence, from which 30-s temporal-resolution multi-phasic DCE-MRI was synthesized based on clinical protocol. A pharmacokinetics-informed neural network was trained to improve the temporal resolution of the multi-phasic DCE before the quantification of pharmacokinetic parameters. Through ten-fold cross-validation, the agreement between pharmacokinetic parameters estimated from synthesized multi-phasic DCE after deep learning inference was assessed against reference parameters from the corresponding quantitative DCE-MRI images. The ability of the deep learning estimated parameters to differentiate abnormal from normal tissues was assessed as well. Results The pharmacokinetic parameters estimated after deep learning have a high level of agreement with the reference values. In the cross-validation, all three pharmacokinetic parameters (transfer constant K trans , fractional extravascular extracellular volume v e , and rate constant k ep ) achieved intraclass correlation coefficient and R2 between 0.84-0.94, and low coefficients of variation (10.1%, 12.3%, and 5.6%, respectively) relative to the reference values. Significant differences were found between healthy pancreas, PDAC tumor and non-tumor, and CP pancreas. Discussion Retrospective quantification (RoQ) of clinical multi-phasic DCE-MRI is possible by deep learning. This technique has the potential to derive quantitative pharmacokinetic parameters from clinical multi-phasic DCE data for a more objective and precise assessment of cancer.
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Affiliation(s)
- Chaowei Wu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Radiology Department, Stanford University, Stanford, CA, United States
| | - Srinivas Gaddam
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Lixia Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Hui Han
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Stephen Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
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Harindranath S, Sundaram S. Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis. Diagnostics (Basel) 2023; 13:diagnostics13101797. [PMID: 37238280 DOI: 10.3390/diagnostics13101797] [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: 03/20/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic pancreatitis (CP) is a known risk factor for pancreatic cancer. CP may present with an inflammatory mass, and differentiation from pancreatic cancer is often difficult. Clinical suspicion of malignancy dictates a need for further evaluation for underlying pancreatic cancer. Imaging modalities remain the mainstay of evaluation for a mass in background CP; however, they have their shortcomings. Endoscopic ultrasound (EUS) has become the go-to investigation. Adjunct modalities such as contrast-harmonic EUS and EUS elastography, as well as EUS-guided sampling using newer-generation needles are useful in differentiating inflammatory from malignant masses in the pancreas. Paraduodenal pancreatitis and autoimmune pancreatitis often masquerade as pancreatic cancer. In this narrative review, we discuss the various modalities used to differentiate inflammatory from malignant masses of the pancreas.
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Affiliation(s)
- Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
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Choi M, Yoon S, Lee Y, Han D. Evaluation of Perfusion Change According to Pancreatic Cancer and Pancreatic Duct Dilatation Using Free-Breathing Golden-Angle Radial Sparse Parallel (GRASP) Magnetic Resonance Imaging. Diagnostics (Basel) 2023; 13:diagnostics13040731. [PMID: 36832219 PMCID: PMC9955363 DOI: 10.3390/diagnostics13040731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To evaluate perfusion changes in the pancreas with pancreatic cancer and pancreatic duct dilatation using dynamic contrast-enhanced MRI (DCE-MRI). METHOD We evaluate the pancreas DCE-MRI of 75 patients. The qualitative analysis includes pancreas edge sharpness, motion artifacts, streak artifacts, noise, and overall image quality. The quantitative analysis includes measuring the pancreatic duct diameter and drawing six regions of interest (ROIs) in the three areas of the pancreas (head, body, and tail) and three vessels (aorta, celiac axis, and superior mesenteric artery) to measure the peak-enhancement time, delay time, and peak concentration. We evaluate the differences in three quantitative parameters among the ROIs and between patients with and without pancreatic cancer. The correlations between pancreatic duct diameter and delay time are also analyzed. RESULTS The pancreas DCE-MRI demonstrates good image quality, and respiratory motion artifacts show the highest score. The peak-enhancement time does not differ among the three vessels or among the three pancreas areas. The peak-enhancement time and concentrations in the pancreas body and tail and the delay time in the three pancreas areas are significantly longer (p < 0.05) in patients with pancreatic cancer than in those without pancreatic cancer. The delay time was significantly correlated with the pancreatic duct diameters in the head (p < 0.02) and body (p < 0.001). CONCLUSION DCE-MRI can display the perfusion change in the pancreas with pancreatic cancer. A perfusion parameter in the pancreas is correlated with the pancreatic duct diameter reflecting a morphological change in the pancreas.
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Affiliation(s)
- Moonhyung Choi
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Seungbae Yoon
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
- Correspondence: ; Tel.: +82-2-2030-4317
| | - Youngjoon Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Dongyeob Han
- Siemens Healthineers Ltd., Seoul 06620, Republic of Korea
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Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Measuring Perfusion in Pancreatic Ductal Adenocarcinoma and Different Tumor Grade: A Preliminary Single Center Study. Diagnostics (Basel) 2023; 13:diagnostics13030521. [PMID: 36766626 PMCID: PMC9914475 DOI: 10.3390/diagnostics13030521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging is a noninvasive imaging modality that can supply information regarding the tumor anatomy and physiology. The aim of the study was to analyze DCE-MRI perfusion parameters in normal pancreatic parenchymal tissue and PDAC and to evaluate the efficacy of this diagnostic modality in determining the tumor grade. METHODS A single-center retrospective study was performed. A total of 28 patients with histologically proven PDAC underwent DCE-MRI; the control group enrolled 14 patients with normal pancreatic parenchymal tissue; the radiological findings were compared with histopathological data. The study patients were further grouped according to the differentiation grade (G value): well- and moderately differentiated and poorly differentiated PDAC. RESULTS The median values of Ktrans, kep and iAUC were calculated lower in PDAC compared with the normal pancreatic parenchymal tissue (p < 0.05). The mean value of Ve was higher in PDAC, compared with the normal pancreatic tissue (p < 0.05). Ktrans, kep and iAUC were lower in poorly differentiated PDAC, whereas Ve showed no differences between groups. CONCLUSIONS Ve and iAUC DCE-MRI perfusion parameters are important as independent diagnostic criteria predicting the probability of PDAC; the Ktrans and iAUC DCE-MRI perfusion parameters may serve as effective independent prognosticators preoperatively identifying poorly differentiated PDAC.
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Wang N, Gaddam S, Xie Y, Christodoulou AG, Wu C, Ma S, Fan Z, Wang L, Lo S, Hendifar AE, Pandol SJ, Li D. Multitasking dynamic contrast enhanced magnetic resonance imaging can accurately differentiate chronic pancreatitis from pancreatic ductal adenocarcinoma. Front Oncol 2023; 12:1007134. [PMID: 36686811 PMCID: PMC9853434 DOI: 10.3389/fonc.2022.1007134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/16/2022] [Indexed: 01/08/2023] Open
Abstract
Background and aims Accurate differentiation of chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) is an area of unmet clinical need. In this study, a novel Multitasking dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) technique was used to quantitatively evaluate the microcirculation properties of pancreas in CP and PDAC and differentiate between them. Methods The Multitasking DCE technique was able to acquire one 3D image per second during the passage of MRI contrast agent, allowing the quantitative estimation of microcirculation properties of tissue, including blood flow Fp, plasma volume fraction vp, transfer constant Ktrans, and extravascular extracellular volume fraction ve. Receiver operating characteristic (ROC) analysis was performed to differentiate the CP pancreas, PDAC pancreas, normal control pancreas, PDAC tumor, PDAC upstream, and PDAC downstream. ROCs from quantitative analysis and conventional analysis were compared. Results Fourteen PDAC patients, 8 CP patients and 20 healthy subjects were prospectively recruited. The combination of Fp, vp, Ktrans, and ve can differentiate CP versus PDAC pancreas with good AUC (AUC [95% CI] = 0.821 [0.654 - 0.988]), CP versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), PDAC pancreas versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC tumor with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC downstream with excellent AUC (0.917 [0.795 - 1.000]), and CP versus PDAC upstream with fair AUC (0.722 [0.465 - 0.980]). This quantitative analysis outperformed conventional analysis in differentiation of each pair. Conclusion Multitasking DCE MRI is a promising clinical tool that is capable of unbiased quantitative differentiation between CP from PDAC.
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Affiliation(s)
- Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Srinivas Gaddam
- The Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Anthony G. Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Bioengineering Department, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chaowei Wu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Bioengineering Department, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sen Ma
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, CA, United States
| | - Lixia Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Simon Lo
- The Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Andrew E. Hendifar
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Stephen J. Pandol
- The Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Bioengineering Department, University of California, Los Angeles, Los Angeles, CA, United States,*Correspondence: Debiao Li,
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Ramachandran A, Madhusudhan KS. Advances in the imaging of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:3008-3026. [PMID: 36051339 PMCID: PMC9331531 DOI: 10.3748/wjg.v28.i26.3008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms comprise a heterogeneous group of tumors that differ in their pathogenesis, hormonal syndromes produced, biological behavior and consequently, in their requirement for and/or response to specific chemotherapeutic agents and molecular targeted therapies. Various imaging techniques are available for functional and morphological evaluation of these neoplasms and the selection of investigations performed in each patient should be customized to the clinical question. Also, with the increased availability of cross sectional imaging, these neoplasms are increasingly being detected incidentally in routine radiology practice. This article is a review of the various imaging modalities currently used in the evaluation of neuroendocrine neoplasms, along with a discussion of the role of advanced imaging techniques and a glimpse into the newer imaging horizons, mostly in the research stage.
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Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
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Szotkowská R, Gojda J, Plíhalová A, Weichet J, Potočková J, Havlík J, Polák J, Anděl M. Visceral Fat Accumulation Is Related to Impaired Pancreatic Blood Perfusion and Beta-Cell Dysfunction in Obese Women. ANNALS OF NUTRITION AND METABOLISM 2021; 77:344-349. [PMID: 34564074 DOI: 10.1159/000519251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
AIMS/HYPOTHESIS Beta-cell failure plays a fundamental role in type 2 diabetes mellitus (T2DM) development. It has been shown that the beta-cells are among the most sensitive to hypoxia. We aimed to analyze whether decrease in pancreatic perfusion relates to 1/decline in beta-cell function and 2/visceral fat accumulation in patients with T2DM. METHODS Fifteen women with T2DM on metformin therapy alone and fifteen women of comparable age and BMI without prediabetes/diabetes were cross-sectionally examined: clinical and anthropometric examination, fast sampled intravenous glucose tolerance test (FSIVGTT), dynamic contrast-enhanced magnetic resonance imaging to assess pancreatic perfusion (area under the curve of postcontrast saturation, AUCTSIC), and visceral adiposity (VAT, calculated from transverse sections at the level L2-L5 vertebrae). RESULTS Pancreatic blood perfusion (AUCTSIC) did not differ between groups (p = 0.273), but it negatively correlated with BMI (r = -0.434, p = 0.017), WHR (r = -0.411, p = 0.024), and VAT (r = -0.436, p = 0.016) in both groups. Moreover, AUCTSIC in the head of the pancreas negatively correlated with the level of fasting glycemia (r = -0.401, p = 0.028) and HOMA-IR (r = -0.376, p = 0.041). DISCUSSION/CONCLUSION We showed that decreased pancreatic perfusion did not relate to beta-cell dysfunction in early stages of T2DM development, but it was related to VAT, insulin resistance, and higher fasting glycemia. Furthermore, lower pancreatic perfusion was related to VAT, insulin resistance, and higher fasting glycemia.
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Affiliation(s)
- Radka Szotkowská
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Centre for Research on Nutrition, Metabolism and Diabetes of Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jan Gojda
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Centre for Research on Nutrition, Metabolism and Diabetes of Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Plíhalová
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Centre for Research on Nutrition, Metabolism and Diabetes of Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jiří Weichet
- Department of Radiodiagnostics, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Potočková
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Centre for Research on Nutrition, Metabolism and Diabetes of Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jan Havlík
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Jan Polák
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Anděl
- Department of Internal Medicine 2, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czechia.,Centre for Research on Nutrition, Metabolism and Diabetes of Third Faculty of Medicine, Charles University, Prague, Czechia
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12
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Kinh Do R, Reyngold M, Paudyal R, Oh JH, Konar AS, LoCastro E, Goodman KA, Shukla-Dave A. Diffusion-Weighted and Dynamic Contrast-Enhanced MRI Derived Imaging Metrics for Stereotactic Body Radiotherapy of Pancreatic Ductal Adenocarcinoma: Preliminary Findings. ACTA ACUST UNITED AC 2021; 6:261-271. [PMID: 32548304 PMCID: PMC7289241 DOI: 10.18383/j.tom.2020.00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We aimed to assess longitudinal changes in quantitative imaging metric values obtained from diffusion-weighted (DW-) and dynamic contrast-enhanced magnetic resonance imaging (DCE)-MRI at pre-treatment (TX[0]), immediately after the first fraction of stereotactic body radiotherapy (D1-TX[1]), and 6 weeks post-TX (Post-TX[2]) in patients with pancreatic ductal adenocarcinoma. Ten enrolled patients (n = 10) underwent DW- and DCE-MRI examinations on a 3.0 T scanner. The apparent diffusion coefficient, ADC (mm2/s), was derived from DW imaging data using a monoexponential model. The tissue relaxation rate, R 1t, time-course data were fitted with a shutter-speed model, which provides estimates of the volume transfer constant, K trans (min-1), extravascular extracellular volume fraction, ve , and mean lifetime of intracellular water protons, τ i (seconds). Wilcoxon rank-sum test compared the mean values, standard deviation, skewness, kurtosis, and relative percentage (r, %) changes (Δ) in ADC, K trans, ve , and τ i values between the magnetic resonance examinations. rADCΔ2-0 values were significantly greater than rADCΔ1-0 values (P = .009). rK trans Δ2-0 values were significantly lower than rK trans Δ1-0 values (P = .048). rve Δ2-1 and rveΔ2-0 values were significantly different (P = .016). rτ i Δ2-1 values were significantly lower than rτ i Δ2-0 values (P = .008). For group comparison, the pre-TX mean and kurtosis of ADC (P = .18 and P = .14), skewness and kurtosis of K trans values (P = .14 for both) showed a leaning toward significant difference between patients who experienced local control (n = 2) and failed early (n = 4). DW- and DCE-MRI-derived quantitative metrics could be useful biomarkers to evaluate longitudinal changes to stereotactic body radiotherapy in patients with pancreatic ductal adenocarcinoma.
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Affiliation(s)
| | | | - Ramesh Paudyal
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Jung Hun Oh
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | | | - Eve LoCastro
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Karyn A Goodman
- Tisch Cancer Institute at Mount Sinai Hospital, New York, NY
| | - Amita Shukla-Dave
- Departments of Radiology.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY; and
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13
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Leow KS, Chieng JSL, Low HM, Lim KS, Kwek JW, Lim TC, Tan CH. Algorithm-based approach to hypervascular pancreatic lesions. Singapore Med J 2021; 62:113-119. [PMID: 33846754 DOI: 10.11622/smedj.2021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kheng Song Leow
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | | | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Jin Wei Kwek
- Division of Oncology Imaging, National Cancer Centre Singapore, Singapore
| | - Tze Chwan Lim
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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14
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Granata V, Fusco R, Sansone M, Grassi R, Maio F, Palaia R, Tatangelo F, Botti G, Grimm R, Curley S, Avallone A, Izzo F, Petrillo A. Magnetic resonance imaging in the assessment of pancreatic cancer with quantitative parameter extraction by means of dynamic contrast-enhanced magnetic resonance imaging, diffusion kurtosis imaging and intravoxel incoherent motion diffusion-weighted imaging. Therap Adv Gastroenterol 2020; 13:1756284819885052. [PMID: 32499833 PMCID: PMC7243396 DOI: 10.1177/1756284819885052] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite great technical advances in imaging, such as multidetector computed tomography and magnetic resonance imaging (MRI), diagnosing pancreatic solid lesions correctly remains challenging, due to overlapping imaging features with benign lesions. We wanted to evaluate functional MRI to differentiate pancreatic tumors, peritumoral inflammatory tissue, and normal pancreatic parenchyma by means of dynamic contrast-enhanced MRI (DCE-MRI)-, diffusion kurtosis imaging (DKI)-, and intravoxel incoherent motion model (IVIM) diffusion-weighted imaging (DWI)-derived parameters. METHODS We retrospectively analyzed 24 patients, each with histopathological diagnosis of pancreatic tumor, and 24 patients without pancreatic lesions. Functional MRI was acquired using a 1.5 MR scanner. Peritumoral inflammatory tissue was assessed by drawing regions of interest on the tumor contours. DCE-MRI, IVIM and DKI parameters were extracted. Nonparametric tests and receiver operating characteristic (ROC) curves were calculated. RESULTS There were statistically significant differences in median values among the three groups observed by Kruskal-Wallis test for the DKI mean diffusivity (MD), IVIM perfusion fraction (fp) and IVIM tissue pure diffusivity (Dt). MD had the best results to discriminate normal pancreas plus peritumoral inflammatory tissue versus pancreatic tumor, to separate normal pancreatic parenchyma versus pancreatic tumor and to differentiate peritumoral inflammatory tissue versus pancreatic tumor, respectively, with an accuracy of 84%, 78%, 83% and area under ROC curve (AUC) of 0.85, 0.82, 0.89. The findings were statistically significant compared with those of other parameters (p value < 0.05 using McNemar's test). Instead, to discriminate normal pancreas versus peritumoral inflammatory tissue or pancreatic tumor and to differentiate normal pancreatic parenchyma versus peritumoral inflammatory tissue, there were no statistically significant differences between parameters' accuracy (p > 0.05 at McNemar's test). CONCLUSIONS Diffusion parameters, mainly MD by DKI, could be helpful for the differentiation of normal pancreatic parenchyma, perilesional inflammation, and pancreatic tumor.
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Affiliation(s)
- Vincenza Granata
- Radiology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Roberta Fusco
- Department of Radiology, Istituto Nazionale Tumori Fondazione G. Pascale, via Mariano Semmola, Naples 80131, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples Federico II, Naples, Italy
| | - Roberto Grassi
- Radiology Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Maio
- Radiology Unit, University of Naples Federico II, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Fabiana Tatangelo
- Diagnostic Pathology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Gerardo Botti
- Diagnostic Pathology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Robert Grimm
- Siemens Healthcare GmbH, Erlangen, Bayern, Germany
| | - Steven Curley
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Antonio Avallone
- Abdominal Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
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15
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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: 2.8] [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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16
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Lee S, Choi YH, Cho YJ, Cheon JE, Moon JS, Kang GH, Kim WS. Quantitative evaluation of Crohn's disease using dynamic contrast-enhanced MRI in children and young adults. Eur Radiol 2020; 30:3168-3177. [PMID: 32078012 DOI: 10.1007/s00330-020-06684-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/25/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the clinical usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in children and young adults with Crohn's disease. METHODS From August 2017 to October 2018, 30 patients with Crohn's disease (21 males and 9 females; mean age 15.1 ± 2.5 years) underwent DCE-MRI with MRI enterography. We assessed the endoscopic finding, pediatric Crohn's disease activity index (PCDAI), C-reactive protein (CRP) level (mg/dL), Crohn's disease MR index (CDMI) score, and the perfusion parameters of DCE-MRI (Ktrans, Kep, and Ve) at the ileocecal region between the inactive and active groups based on the histopathologic status. RESULTS The active Crohn's disease group showed higher PCDAI, CRP, and CDMI scores than the inactive group (22.2 ± 18.8 vs. 6.3 ± 6.4, p = 0.027; 1.32 ± 1.79 vs. 0.10 ± 0.13, p = 0.005; 7.4 ± 3.9 vs. 4.5 ± 3.0, p = 0.047, respectively). The active Crohn's disease group showed a higher Ktrans value than the inactive group (0.31 ± 0.12 vs. 0.16 ± 0.46 min-1, p = 0.002). Endoscopic finding; PCDAI, CRP, and CDMI scores; and Ktrans value were significant parameters in the identification of the active Crohn's disease (p = 0.002, p < 0.001, p = 0.029, p = 0.006, and p < 0.001, respectively). Ktrans value was the most significant value for identifying active Crohn's disease in the multivariate logistic regression analysis (p = 0.013). CONCLUSION Ktrans value could discriminate between inactive and active Crohn's diseases. Ktrans value may have the potential to monitor the pediatric Crohn's disease activity. KEY POINTS • With dynamic contrast-enhanced MRI, we can quantitatively monitor the Crohn's disease status in pediatric patients and provide proper management plans to clinicians. • The Ktransvalue of dynamic contrast-enhanced MRI perfusion parameter, as well as the clinical pediatric Crohn's disease activity index, C-reactive protein level, the endoscopic score, and the Crohn's disease MR index, was higher in the active Crohn's disease than in the inactive group based on the histopathologic status. • The Ktransvalue among the dynamic contrast-enhanced MRI perfusion parameters was the most significant differentiating parameter for the active Crohn's disease from inactive status among those parameters (p = 0.013).
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Affiliation(s)
- Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Hun Choi
- 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 (Baltimore), 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung-Eun Cheon
- 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 (Baltimore), 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine (Baltimore), Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Gyeong Hoon Kang
- Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Woo Sun 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 (Baltimore), 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine (Baltimore), Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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17
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Wang N, Gaddam S, Wang L, Xie Y, Fan Z, Yang W, Tuli R, Lo S, Hendifar A, Pandol S, Christodoulou AG, Li D. Six-dimensional quantitative DCE MR Multitasking of the entire abdomen: Method and application to pancreatic ductal adenocarcinoma. Magn Reson Med 2020; 84:928-948. [PMID: 31961967 DOI: 10.1002/mrm.28167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/09/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a quantitative DCE MRI technique enabling entire-abdomen coverage, free-breathing acquisition, 1-second temporal resolution, and T1 -based quantification of contrast agent concentration and kinetic modeling for the characterization of pancreatic ductal adenocarcinoma (PDAC). METHODS Segmented FLASH readouts following saturation-recovery preparation with randomized 3D Cartesian undersampling was used for incoherent data acquisition. MR Multitasking was used to reconstruct 6-dimensional images with 3 spatial dimensions, 1 T1 recovery dimension for dynamic T1 quantification, 1 respiratory dimension to resolve respiratory motion, and 1 DCE time dimension to capture the contrast kinetics. Sixteen healthy subjects and 14 patients with pathologically confirmed PDAC were recruited for the in vivo studies, and kinetic parameters vp , Ktrans , ve , and Kep were evaluated for each subject. Intersession repeatability of Multitasking DCE was assessed in 8 repeat healthy subjects. One-way unbalanced analysis of variance was performed between control and patient groups. RESULTS In vivo studies demonstrated that vp , Ktrans , and Kep of PDAC were significantly lower compared with nontumoral regions in the patient group (P = .002, .003, .004, respectively) and normal pancreas in the control group (P = .011, <.001, <.001, respectively), while ve was significantly higher than nontumoral regions (P < .001) and healthy pancreas (P < .001). The kinetic parameters showed good in vivo repeatability (interclass correlation coefficient: vp , 0.95; Ktrans , 0.98; ve , 0.96; Kep , 0.99). CONCLUSION The proposed Multitasking DCE is promising for the quantification of vascular properties of PDAC. Quantitative DCE parameters were repeatable in vivo and showed significant differences between normal pancreas and both tumor and nontumoral regions in patients with PDAC.
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Affiliation(s)
- Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Srinivas Gaddam
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lixia Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Wensha Yang
- Department of Clinical Radiation Oncology, University of Southern California, Los Angeles, California
| | - Richard Tuli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon Lo
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Hendifar
- Department of Gastrointestinal Malignancies, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen Pandol
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
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18
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Tom WJ, Xu X, Vahdat N, Cassidy F, Aganovic L. Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor. Clin Imaging 2020; 59:39-44. [PMID: 31756593 PMCID: PMC6938461 DOI: 10.1016/j.clinimag.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory pseudotumors imitate neoplasms on imaging but actually represent focal inflammation. We report a case of follicular pancreatitis, which is a recently recognized distinct form of mass-forming focal chronic pancreatitis pathologically characterized by lymphoid infiltration with abundant reactive germinal centers. In our patient, follicular pancreatitis manifested as a pancreatic tail mass that was resected due to imaging findings, which were suggestive of pancreatic malignancy. We performed a literature review of this rare condition and present a summary of reported imaging findings. The most distinguishing feature from pancreatic adenocarcinoma is the enhancement pattern, as follicular pancreatitis enhances more than the surrounding pancreatic parenchyma on delayed post-contrast images which is unusual for pancreatic adenocarcinoma. If this benign diagnosis is suggested on imaging, unnecessary surgery and its potential complications may be avoided.
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Affiliation(s)
- W James Tom
- Department of Radiology, University of California San Diego, San Diego, CA, USA.
| | - Xiangdong Xu
- Department of Pathology, University of California San Diego, San Diego, CA, USA; Department of Pathology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Noushin Vahdat
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Fiona Cassidy
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lejla Aganovic
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
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19
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Hu R, Yang H, Chen Y, Zhou T, Zhang J, Chen TW, Zhang XM. Dynamic Contrast-Enhanced MRI for Measuring Pancreatic Perfusion in Acute Pancreatitis: A Preliminary Study. Acad Radiol 2019; 26:1641-1649. [PMID: 30885415 DOI: 10.1016/j.acra.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the characteristics of pancreatic perfusion in normal pancreas and acute pancreatitis (AP) by using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). METHOD AND MATERIALS Eighty-One AP patients and 26 normal subjects underwent DCE-MRI. The Omitk-Tool was used to analyze perfusion parameters such as Ktrans, Vp, and AUC. The parameters of pancreas between AP and control groups were compared. In AP patients, the parameters were compared between edematous and necrotizing pancreatitis and among different grades of AP as determined by MR severity index (MRSI) and the 2012 Revised Atlanta Classification of AP. RESULTS The Ktrans, Vp, and AUC values of AP were lower than those of the control group (p = 0.007, 0.000, and 0.025). According to MRSI, the Ktrans and AUC values were significantly different between mild and moderate (p = 0.000, 0.000) and between mild and severe (p = 0.008, 0.016) AP but not between moderate and severe AP (p = 0.218, 0.217). Based on the 2012 Revised Atlanta Classification, the Ktrans values were significantly different between mild and moderately severe (p = 0.000) and between mild and severe (p = 0.005) AP, but not between moderately severe and severe AP (p = 0.619). The Ktrans values were significantly different between edematous and necrotizing pancreatitis (p = 0.03). CONCLUSION The application of DCE-MRI to evaluate pancreatic perfusion contributes to the diagnosis of AP and its severity grade. Pancreatic perfusion is lower in AP patients than in patients with a normal pancreas, and pancreatic perfusion tends to decrease as the severity of AP increases.
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Affiliation(s)
- Ran Hu
- Chongqing Traditional Chinese Medicine Hospital, Department of Radiology, No.6, Panxi 7th Road, Jiangbei District, Chongqing 400021, China
| | - Hua Yang
- Chongqing Traditional Chinese Medicine Hospital, Department of Radiology, No.6, Panxi 7th Road, Jiangbei District, Chongqing 400021, China.
| | - Yong Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.234, Fujiang Road, Shunqing District, Nanchong 637000, China
| | - Ting Zhou
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.234, Fujiang Road, Shunqing District, Nanchong 637000, China
| | - Ju Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.234, Fujiang Road, Shunqing District, Nanchong 637000, China
| | - Tian Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.234, Fujiang Road, Shunqing District, Nanchong 637000, China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, No.234, Fujiang Road, Shunqing District, Nanchong 637000, China.
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20
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Tang W, Liu W, Li HM, Wang QF, Fu CX, Wang XH, Zhou LP, Peng WJ. Quantitative dynamic contrast-enhanced MR imaging for the preliminary prediction of the response to gemcitabine-based chemotherapy in advanced pancreatic ductal carcinoma. Eur J Radiol 2019; 121:108734. [PMID: 31743881 DOI: 10.1016/j.ejrad.2019.108734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/15/2019] [Accepted: 10/27/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the role of the quantitative parameters of dynamic contrast-enhanced MR imaging (DCE-MRI) in the prediction of the response to chemotherapy in pancreatic ductal carcinoma (PDC). METHOD Forty patients with histologically confirmed PDC who underwent quantitative DCE-MRI were retrospectively analyzed. All patients were divided into groups of responders and nonresponders. DCE-MRI parameters, including the volume transfer constant (Ktrans), the extracellular extravascular volume fraction (ve), the rate constant (kep) and the initial area under the concentration curve in 60 s (iAUC60), were measured and compared. DCE-MRI parameters were obtained from different ROIs. RESULTS The values of Ktrans in responders with peripheral, whole tumor slice, and adjacent non-tumorous region ROIs were significantly higher than those in nonresponders (P = 0.015, 0.043, and 0.025, respectively). Responders showed a significantly higher kep with peripheral area ROI compared with nonresponders (P = 0.013). Ve and iAUC60 with all ROIs were not significantly different between responders and nonresponders (P = 0.140-0.968). Kep with periphery ROI showed the highest area under the ROC curve (AUC) of 0.806, but there were no statistical differences when compared with values of Ktrans.There were statistically significant differences for DCE-MRI parameters among four ROIs (all P < 0.05). All parameters showed good to excellent intra and interobserver agreement. CONCLUSIONS Quantitative parameters derived from DCE-MRI might be a potential predictor of response to gemcitabine in patients with PDC. Perfusion parameters were diverse depending on the location of the ROI on different tumoral and peritumoral areas.
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Affiliation(s)
- Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Wei Liu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Hai-Ming Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Qi-Feng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Cai-Xia Fu
- MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Xiao-Hong Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
| | - Liang-Ping Zhou
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.
| | - Wei-Jun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.
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21
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Fan R, Zhu H, Niu J, Li J, Zheng R, Song X. Correlation of histological marrow characteristics and intravoxel incoherent motion-derived parameters in benign and malignant hematological disorders. Eur J Radiol 2019; 123:108745. [PMID: 31899061 DOI: 10.1016/j.ejrad.2019.108745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the relationship between intravoxel incoherent motion (IVIM) parameters and histological parameters of vascularity and cellularity in marrow of hyperplasia disease and compare the difference between benign and malignant marrow disorders. METHODS From August 2016 to March 2017, 43 newly diagnosed patients were recruited, which included 15 anemia patients (benign hemopathy) and 28 patients with acute leukemia (AL) (malignant hemopathy). All patients underwent IVIM in the lumbar marrow and the D, D*, f values were measured. The microvessel density (MVD) and cellularity of marrow were calculated from the sample of iliac crest biopsy. Pearson correlation analysis was used to study the relationship between IVIM-derived and histology-derived parameters. We performed unpaired t test to analyze the differences of all parameters between AL and anemia. RESULT The MVD was positively correlated with f in patients with AL, anemia and both of them (r = 0.692, P < 0.001; r = 0.595, P = 0.019; r = 0.673, P < 0.001, respectively). But there was no correlation between D* and MVD in three groups. D was not related to bone marrow cellularity (BMC) in all groups. In addition, the f and MVD were higher in AL than anemia (t = 3.546, P = 0.001; t = 6.695, P < 0.001, respectively). The BMC was significantly higher in AL than in anemia (t = 3.330, P = 0.004), but D and D* value had no significant difference between the two groups. CONCLUSION The blood volume fraction f was positively correlated with the histological features of marrow in hematological disorders, while f can show the difference of vascularity between benign and malignant marrow disease.
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Affiliation(s)
- Rong Fan
- Department of Radiology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, 030001, China
| | - Hong Zhu
- Department of Radiology, Children's Hospital of Shanxi, 13 Xinmin North Street, Taiyuan, Shanxi, 030001, China
| | - Jinliang Niu
- Department of Radiology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, 030001, China.
| | - Jianting Li
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, China
| | - Rong Zheng
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, Shanxi, 030001, China
| | - Xiaoli Song
- Department of Radiology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, 030001, China
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22
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Wolske KM, Ponnatapura J, Kolokythas O, Burke LMB, Tappouni R, Lalwani N. Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach. Radiographics 2019; 39:1965-1982. [PMID: 31584860 DOI: 10.1148/rg.2019190011] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacks are available for this article. ©RSNA, 2019.
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Affiliation(s)
- Kristy Marie Wolske
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Janardhana Ponnatapura
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Orpheus Kolokythas
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Lauren M B Burke
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Rafel Tappouni
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Neeraj Lalwani
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
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23
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Donati F, Boraschi P, Cervelli R, Pacciardi F, Lombardo C, Boggi U, Falaschi F, Caramella D. 3 T MR perfusion of solid pancreatic lesions using dynamic contrast-enhanced DISCO sequence: Usefulness of qualitative and quantitative analyses in a pilot study. Magn Reson Imaging 2019; 59:105-113. [DOI: 10.1016/j.mri.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 12/15/2022]
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24
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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: 20] [Impact Index Per Article: 4.0] [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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25
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Choe J, Kim KW, Kim HJ, Kim DW, Kim KP, Hong SM, Ryu JS, Tirumani SH, Krajewski K, Ramaiya N. What Is New in the 2017 World Health Organization Classification and 8th American Joint Committee on Cancer Staging System for Pancreatic Neuroendocrine Neoplasms? Korean J Radiol 2018; 20:5-17. [PMID: 30627018 PMCID: PMC6315069 DOI: 10.3348/kjr.2018.0040] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
The diagnosis and management of pancreatic neuroendocrine neoplasms (NENs) have evolved significantly in recent years. There are several diagnostic and therapeutic challenges and controversies regarding the management of these lesions. In this review, we focus on the recent significant changes and controversial issues regarding the diagnosis and management of NENs and discuss the role of imaging in the multidisciplinary team approach.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyu Pyo Kim
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikhil Ramaiya
- Department of Imaging, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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26
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova J. Functional imaging in pancreatic disease. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova JC. Functional imaging in pancreatic disease. RADIOLOGIA 2018; 60:451-464. [PMID: 30236460 DOI: 10.1016/j.rx.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.
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Affiliation(s)
- S Baleato-González
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - R García-Figueiras
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - A Luna
- Grupo Health Time. Director - Advanced Medical Imaging, Sercosa (Servicio de Radiología Computerizada), Clínica Las Nieves, Jaén, España
| | - M Domínguez-Robla
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J C Vilanova
- Departamento de Radiología, Clínica Girona-Hospital Santa Caterina, Girona, España
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28
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Guo C, Chen X, Wang Z, Xiao W, Wang Q, Sun K, Zhuge X. Differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma using magnetic resonance imaging: The value of contrast-enhanced and diffusion weighted imaging. Oncotarget 2018; 8:42962-42973. [PMID: 28487490 PMCID: PMC5522119 DOI: 10.18632/oncotarget.17309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/05/2017] [Indexed: 12/13/2022] Open
Abstract
Pancreatic neuroendocrine carcinoma (PNEC) is often misdiagnosed as pancreatic ductal adenocarcinoma (PDAC). This retrospective study differentiated PNEC from PDAC using magnetic resonance imaging (MRI), including contrast-enhanced (CE) and diffusion-weighted imaging (DWI). Clinical data and MRI findings, including the T1/T2 signal, tumor boundary, size, enhancement degree, and apparent diffusion coefficient (ADC), were compared between 37 PDACs and 13 PNECs. Boundaries were more poorly defined in PDAC than PNEC (97.3% vs. 61.5%, p<0.01). Hyper-/isointensity was more common in PNEC than PDAC at the arterial (38.5% vs. 0.0), portal (46.2% vs. 2.7%) and delayed phases (46.2% vs. 5.4%) (all p<0.01). Lymph node metastasis (97.3% vs. 61.5%, p<0.01) and local invasion/distant metastasis (86.5% vs. 46.2%, p<0.01) were more common in PDAC than PNEC. Enhancement degree via CE-MRI was higher in PNEC than PDAC at the arterial and portal phases (p<0.01). PNEC ADC values were lower than those of normal pancreatic parenchyma (p<0.01) and PDAC (p<0.01). Arterial and portal phase signal intensity ratios and ADC values showed the largest areas under the receiver operating characteristic curve and good sensitivities (92.1%–97.2%) and specificities (76.9%–92.3%) for differentiating PNEC from PDAC. Thus the enhancement degree at the arterial and portal phases and the ADC values may be useful for differentiating PNEC from PDAC using MRI.
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Affiliation(s)
- Chuangen Guo
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, China.,Division of Nephrology, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, China
| | - Wenbo Xiao
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
| | - Qidong Wang
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
| | - Ke Sun
- Department of Pathology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
| | - Xiaoling Zhuge
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, China
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29
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Yan Y, Sun X, Shen B. Contrast agents in dynamic contrast-enhanced magnetic resonance imaging. Oncotarget 2018; 8:43491-43505. [PMID: 28415647 PMCID: PMC5522164 DOI: 10.18632/oncotarget.16482] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/15/2017] [Indexed: 12/19/2022] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a noninvasive method to assess angiogenesis, which is widely used in clinical applications including diagnosis, monitoring therapy response and prognosis estimation in cancer patients. Contrast agents play a crucial role in DCE-MRI and should be carefully selected in order to improve accuracy in DCE-MRI examination. Over the past decades, there was much progress in the development of optimal contrast agents in DCE-MRI. In this review, we describe the recent research advances in this field and discuss properties of contrast agents, as well as their advantages and disadvantages. Finally, we discuss the research perspectives for improving this promising imaging method.
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Affiliation(s)
- Yuling Yan
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xilin Sun
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Baozhong Shen
- Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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30
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Chen BB, Tien YW, Chang MC, Cheng MF, Chang YT, Yang SH, Wu CH, Kuo TC, Shih IL, Yen RF, Shih TTF. Multiparametric PET/MR imaging biomarkers are associated with overall survival in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging 2018; 45:1205-1217. [PMID: 29476229 DOI: 10.1007/s00259-018-3960-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI in patients with pancreatic cancer. METHODS This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters (peak, IAUC 60 , K trans , k ep , v e ), the minimum apparent diffusion coefficient (ADCmin), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models. RESULTS Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P = 0.041), high peak (P = 0.006), high ADCmin (P = 0.002) and low TLG (P = 0.01) had better OS. Moreover, high TLG/peak ratio was associated with poor OS (P = 0.016). Multivariate analysis indicated that ADCmin (P = 0.011) and TLG/peak ratio (P = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery (P = 0.013). CONCLUSION The flow-metabolism mismatch reflected by the TLG/peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ming-Chu Chang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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31
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Klaassen R, Gurney-Champion OJ, Wilmink JW, Besselink MG, Engelbrecht MRW, Stoker J, Nederveen AJ, van Laarhoven HWM. Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma. Magn Reson Imaging 2018; 50:1-9. [PMID: 29476781 DOI: 10.1016/j.mri.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/15/2018] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND In current oncological practice of pancreatic ductal adenocarcinoma (PDAC), there is a great demand for response predictors and markers for early treatment evaluation. In this study, we investigated the repeatability and the interaction of dynamic contrast enhanced (DCE) and T2* MRI in patients with advanced PDAC to enable for such evaluation using these techniques. MATERIALS & METHODS 15 PDAC patients underwent two DCE, T2* and anatomical 3 T MRI sessions before start of treatment. Parametric maps were calculated for the transfer constant (Ktrans), rate constant (kep), extracellular extravascular space (ve) and perfusion fraction (vp). Quantitative R2* (1/T2*) maps were obtained from the multi-echo T2* images. Differences between normal and cancerous pancreas were determined using a Wilcoxon matched pairs test. Repeatability was obtained using Bland-Altman analysis and relations between DCE and T2*/R2* were observed by Spearman correlation and voxel-wise binned plots of tumor voxels. RESULTS PDAC Ktrans (p = 0.007), kep (p < 0.001), vp (p = 0.035) were lower and ve (p < 0.001) was higher compared to normal pancreas. The coefficient of variation between sessions was 21.8% for Ktrans, 9.9% for kep, 19.3% for ve, 18.2% for vp and 18.7% for R2*. Variation between patients ranged from 20.2% for kep to 43.6% for Ktrans. In the tumor both Ktrans (r = 0.56, p = 0.030) and ve (r = 0.54, p = 0.037) showed a positive correlation with T2*. Voxel wise analysis showed a steep increase in R2* for tumor voxels with lower Ktrans and ve. CONCLUSION We showed good repeatability of DCE and T2* related MRI parameters in advanced PDAC patients. Furthermore, we have illustrated the relation of DCE Ktrans and ve with tissue T2* and R2* indicating substantial value of these parameters for detecting tumor hypoxia in future studies. The results from our study pave the way for further response evaluation studies and patient selection based on DCE and T2* parameters.
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Affiliation(s)
- Remy Klaassen
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Cancer Center Amsterdam, LEXOR (Laboratory for Experimental Oncology and Radiobiology), Academic Medical Center, Amsterdam, The Netherlands.
| | - Oliver J Gurney-Champion
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc R W Engelbrecht
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
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32
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Noda Y, Goshima S, Namimoto T, Shinkawa N, Nakagawa M, Kajita K, Kawada H, Kawai N, Tanahashi Y, Matsuo M, Bae KT, Hirai T, Yamashita Y. Simultaneous acquisition of MR angiography and diagnostic images of abdomen at view-sharing multiarterial phases and comparing the effect of two different contrast agents. J Magn Reson Imaging 2017; 48:102-110. [PMID: 29247585 DOI: 10.1002/jmri.25925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/21/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Simultaneous acquisition of magnetic resonance angiography (MRA) and diagnostic images is challenging in contrast-enhanced upper abdominal MRI. PURPOSE To evaluate the image quality of MRA of the abdomen acquired simultaneously with diagnostic MR images, and to compare the contrast effect, conspicuity of aortic branches, and pancreatic lesions in MRA between gadobutrol and gadoterate meglumine. STUDY TYPE Prospective. POPULATION Eighty-eight patients with known and suspected upper abdominal disease. FIELD STRENGTH/SEQUENCES 3T/4D-eTHRIVE (T1 -weighted fat-suppressed 3D fast gradient echo) for multiarterial phase imaging. ASSESSMENT The artery-to-muscle signal intensity ratio (SIR), conspicuity of aortic branches on the axial, maximum intensity projection (MIP), and volume-rendered (VR) images, and conspicuity of focal pancreatic lesions were compared between gadobutrol and gadoterate meglumine. The diameters of aortic branches were measured on axial MRA and computed tomography angiography (CTA) images and then compared. STATISTICAL TESTS Quantitative and qualitative data were assessed with the Mann-Whitney U-test. The diameters of aortic branches between MRA and CTA were compared with a Spearman rank correlation test. RESULTS View-sharing multiarterial phase imaging was successfully performed in all patients. The SIRs of common hepatic artery (P = 0.0051) and left renal artery (RA) (P = 0.045), vascular conspicuities of right and left hepatic arteries (P = 0.010 and 0.030) and right and left RAs on axial (P = 0.0065 and 0.036), and that of gastroduodenal artery on MIP (P = 0.039) with gadobutrol were significantly higher than those with gadoterate meglumine. The conspicuity of focal pancreatic lesions were comparable between the gadobutrol and gadoterate meglumine (P = 0.73). The vascular diameters on MRA and CTA were strongly correlated in all aortic branches (r = 0.842-0.942, P < 0.0001). DATA CONCLUSION High-quality MRA of the abdomen was obtained simultaneously with the diagnostic MR images using view-sharing multiarterial phase imaging that also demonstrated comparable image quality between gadobutrol and gadoterate meglumine. LEVEL OF EVIDENCE 2 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017.
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Affiliation(s)
| | | | - Tomohiro Namimoto
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
| | - Norihiro Shinkawa
- Department of Diagnostic Radiology, Faculty of Life Sciences, University of Miyazaki, Miyazaki, Japan
| | - Masataka Nakagawa
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, University of Miyazaki, Miyazaki, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Medicine, Kumamoto University, Kumamoto, Japan
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Wegner CS, Hauge A, Gaustad JV, Andersen LMK, Simonsen TG, Galappathi K, Rofstad EK. Dynamic contrast-enhanced MRI of the microenvironment of pancreatic adenocarcinoma xenografts. Acta Oncol 2017; 56:1754-1762. [PMID: 28661213 DOI: 10.1080/0284186x.2017.1343494] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease with poor outcome. Resistance to treatment is associated with impaired vascularity, extensive hypoxia, and interstitial hypertension. In this study, the potential of dynamic contrast-enhanced (DCE)-MRI as a method for assessing the microvascular density (MVD), the fraction of hypoxic tissue, and the interstitial fluid pressure (IFP) of PDACs was investigated. MATERIAL AND METHODS Intramuscular BxPC-3, Capan-2, MIAPaCa-2, and Panc-1 PDAC xenografts were used as preclinical models of human PDACs. DCE-MRI with Gd-DOTA as contrast agent was conducted with a 7.05-T scanner, and the DCE-MRI series were analyzed voxelwise by using the Tofts pharmacokinetic model. Tumor MVD and hypoxia were measured in histological preparations by using pimonidazole as a hypoxia marker and CD31 as a marker of endothelial cells. IFP was measured with a Millar catheter. RESULTS Ktrans (the volume transfer constant of Gd-DOTA) increased with increasing MVD and decreased with increasing hypoxic fraction, but was not associated with IFP. Any association between ve (the fractional distribution volume of Gd-DOTA) and MVD, hypoxic fraction, or IFP could not be detected. CONCLUSIONS This study shows that DCE-MRI is a useful modality for assessing important features of the microenvironment of PDAC xenografts and thus provides the basis for future preclinical and clinical DCE-MRI investigations of PDAC.
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Affiliation(s)
- Catherine S. Wegner
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Anette Hauge
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Jon-Vidar Gaustad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Lise Mari K. Andersen
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Trude G. Simonsen
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Kanthi Galappathi
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Einar K. Rofstad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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Yin T, Liu Y, Peeters R, Feng Y, Ni Y. Pancreatic imaging: Current status of clinical practices and small animal studies. World J Methodol 2017; 7:101-107. [PMID: 29026690 PMCID: PMC5618143 DOI: 10.5662/wjm.v7.i3.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/22/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023] Open
Abstract
Different causative factors acting on the pancreas can result in diseases such as pancreatitis, diabetes and pancreatic tumors. The high incidence and mortality of pancreatic diseases have placed diagnostic imaging in a crucial position in daily clinical practice. In this mini-review article different pancreatic imaging techniques are discussed, from the standard clinical imaging modalities and state of the art clinical magnetic resonance imaging techniques to current situations in pre-clinical pancreatic imaging studies. In particular, the challenges of pre-clinical rodent pancreatic imaging are addressed, with both the image acquisition techniques and the post-processing methods for rodent pancreatic imaging elaborated.
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Affiliation(s)
- Ting Yin
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, 3000 Leuven, Belgium
| | - Yewei Liu
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, 3000 Leuven, Belgium
| | - Ronald Peeters
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, 3000 Leuven, Belgium
| | - Yuanbo Feng
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, 3000 Leuven, Belgium
| | - Yicheng Ni
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, 3000 Leuven, Belgium
- Department of Radiology, University Hospitals, KU Leuven, 3000 Leuven, Belgium
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PET-MRI of the Pancreas and Kidneys. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Best LMJ, Rawji V, Pereira SP, Davidson BR, Gurusamy KS. Imaging modalities for characterising focal pancreatic lesions. Cochrane Database Syst Rev 2017; 4:CD010213. [PMID: 28415140 PMCID: PMC6478242 DOI: 10.1002/14651858.cd010213.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasing numbers of incidental pancreatic lesions are being detected each year. Accurate characterisation of pancreatic lesions into benign, precancerous, and cancer masses is crucial in deciding whether to use treatment or surveillance. Distinguishing benign lesions from precancerous and cancerous lesions can prevent patients from undergoing unnecessary major surgery. Despite the importance of accurately classifying pancreatic lesions, there is no clear algorithm for management of focal pancreatic lesions. OBJECTIVES To determine and compare the diagnostic accuracy of various imaging modalities in detecting cancerous and precancerous lesions in people with focal pancreatic lesions. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, and Science Citation Index until 19 July 2016. We searched the references of included studies to identify further studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA We planned to include studies reporting cross-sectional information on the index test (CT (computed tomography), MRI (magnetic resonance imaging), PET (positron emission tomography), EUS (endoscopic ultrasound), EUS elastography, and EUS-guided biopsy or FNA (fine-needle aspiration)) and reference standard (confirmation of the nature of the lesion was obtained by histopathological examination of the entire lesion by surgical excision, or histopathological examination for confirmation of precancer or cancer by biopsy and clinical follow-up of at least six months in people with negative index tests) in people with pancreatic lesions irrespective of language or publication status or whether the data were collected prospectively or retrospectively. DATA COLLECTION AND ANALYSIS Two review authors independently searched the references to identify relevant studies and extracted the data. We planned to use the bivariate analysis to calculate the summary sensitivity and specificity with their 95% confidence intervals and the hierarchical summary receiver operating characteristic (HSROC) to compare the tests and assess heterogeneity, but used simpler models (such as univariate random-effects model and univariate fixed-effect model) for combining studies when appropriate because of the sparse data. We were unable to compare the diagnostic performance of the tests using formal statistical methods because of sparse data. MAIN RESULTS We included 54 studies involving a total of 3,196 participants evaluating the diagnostic accuracy of various index tests. In these 54 studies, eight different target conditions were identified with different final diagnoses constituting benign, precancerous, and cancerous lesions. None of the studies was of high methodological quality. None of the comparisons in which single studies were included was of sufficiently high methodological quality to warrant highlighting of the results. For differentiation of cancerous lesions from benign or precancerous lesions, we identified only one study per index test. The second analysis, of studies differentiating cancerous versus benign lesions, provided three tests in which meta-analysis could be performed. The sensitivities and specificities for diagnosing cancer were: EUS-FNA: sensitivity 0.79 (95% confidence interval (CI) 0.07 to 1.00), specificity 1.00 (95% CI 0.91 to 1.00); EUS: sensitivity 0.95 (95% CI 0.84 to 0.99), specificity 0.53 (95% CI 0.31 to 0.74); PET: sensitivity 0.92 (95% CI 0.80 to 0.97), specificity 0.65 (95% CI 0.39 to 0.84). The third analysis, of studies differentiating precancerous or cancerous lesions from benign lesions, only provided one test (EUS-FNA) in which meta-analysis was performed. EUS-FNA had moderate sensitivity for diagnosing precancerous or cancerous lesions (sensitivity 0.73 (95% CI 0.01 to 1.00) and high specificity 0.94 (95% CI 0.15 to 1.00), the extremely wide confidence intervals reflecting the heterogeneity between the studies). The fourth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (dysplasia) provided three tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing invasive carcinoma were: CT: sensitivity 0.72 (95% CI 0.50 to 0.87), specificity 0.92 (95% CI 0.81 to 0.97); EUS: sensitivity 0.78 (95% CI 0.44 to 0.94), specificity 0.91 (95% CI 0.61 to 0.98); EUS-FNA: sensitivity 0.66 (95% CI 0.03 to 0.99), specificity 0.92 (95% CI 0.73 to 0.98). The fifth analysis, of studies differentiating cancerous (high-grade dysplasia or invasive carcinoma) versus precancerous (low- or intermediate-grade dysplasia) provided six tests in which meta-analysis was performed. The sensitivities and specificities for diagnosing cancer (high-grade dysplasia or invasive carcinoma) were: CT: sensitivity 0.87 (95% CI 0.00 to 1.00), specificity 0.96 (95% CI 0.00 to 1.00); EUS: sensitivity 0.86 (95% CI 0.74 to 0.92), specificity 0.91 (95% CI 0.83 to 0.96); EUS-FNA: sensitivity 0.47 (95% CI 0.24 to 0.70), specificity 0.91 (95% CI 0.32 to 1.00); EUS-FNA carcinoembryonic antigen 200 ng/mL: sensitivity 0.58 (95% CI 0.28 to 0.83), specificity 0.51 (95% CI 0.19 to 0.81); MRI: sensitivity 0.69 (95% CI 0.44 to 0.86), specificity 0.93 (95% CI 0.43 to 1.00); PET: sensitivity 0.90 (95% CI 0.79 to 0.96), specificity 0.94 (95% CI 0.81 to 0.99). The sixth analysis, of studies differentiating cancerous (invasive carcinoma) from precancerous (low-grade dysplasia) provided no tests in which meta-analysis was performed. The seventh analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) provided two tests in which meta-analysis was performed. The sensitivity and specificity for diagnosing cancer were: CT: sensitivity 0.83 (95% CI 0.68 to 0.92), specificity 0.83 (95% CI 0.64 to 0.93) and MRI: sensitivity 0.80 (95% CI 0.58 to 0.92), specificity 0.81 (95% CI 0.53 to 0.95), respectively. The eighth analysis, of studies differentiating precancerous or cancerous (intermediate- or high-grade dysplasia or invasive carcinoma) from precancerous (low-grade dysplasia) or benign lesions provided no test in which meta-analysis was performed.There were no major alterations in the subgroup analysis of cystic pancreatic focal lesions (42 studies; 2086 participants). None of the included studies evaluated EUS elastography or sequential testing. AUTHORS' CONCLUSIONS We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons.
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Affiliation(s)
- Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Vishal Rawji
- University College London Medical SchoolLondonUK
| | - Stephen P Pereira
- Royal Free Hospital CampusUCL Institute for Liver and Digestive HealthUpper 3rd FloorLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
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Guo C, Chen X, Xiao W, Wang Q, Sun K, Wang Z. Pancreatic neuroendocrine neoplasms at magnetic resonance imaging: comparison between grade 3 and grade 1/2 tumors. Onco Targets Ther 2017; 10:1465-1474. [PMID: 28331340 PMCID: PMC5349505 DOI: 10.2147/ott.s127803] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The grading of pancreatic neuroendocrine neoplasms (PanNENs) is associated with the choice of treatment strategy. The aim of this study is to identify the magnetic resonance imaging (MRI) features in differentiating pancreatic neuroendocrine tumors (PanNETs) grade 1/2 (G1/G2) and pancreatic neuroendocrine carcinoma grade 3 (PanNEC G3). Patients and methods A total of 59 patients with histologically proven PanNENs and who underwent pretreatment MRI were retrospectively analyzed. Tumor location, size, boundary, cystic or solid appearance, enhancement degree, pancreatic duct dilatation, metastases and MRI signal were evaluated. Apparent diffusion coefficients (ADCs) were measured on ADC maps. Receiver operating characteristic curve was used to determine the cut off values and the sensitivity and specificity of prediction. Spearman correlation and logistic regression analysis were adopted to identify the association between MRI features and pathological parameters. Results A total of 47 lesions were PanNETs G1/G2 and 12 lesions were PanNEC G3. G1/G2 tumors were more common with well-circumscribed border compared with PanNEC G3. Ill- defined boundary, big size, necrosis, low-moderate enhancement, pancreatic duct dilatation, metastases and high diffusion-weighted imaging (DWI) intensity were more common in PanNEC G3 than in PanNETs G1/G2. The ADC values of PanNEC G3 were also significantly lower compared with the PanNETs G1/G2 and normal pancreatic parenchyma. The cut off value of ADC was 0.95×10−3 mm2/s for differentiating PanNEC G3 from PanNETs G1/G2 with 72.3% sensitivity and 91.6% specificity, respectively. Ki-67 index and mitosis count positively correlated with tumor size, pancreatic duct dilatation and metastases (P<0.05) and negatively correlated with ADC values (P<0.01), respectively. Regression analysis further showed that metastases and ADC value were associated with PanNENs grade. Conclusion Metastases and ADC value may have potential for differentiating PanNEC G3 from PanNETs G1/G2.
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Affiliation(s)
- Chuangen Guo
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing
| | - Wenbo Xiao
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou
| | - Qidong Wang
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou
| | - Ke Sun
- Department of Pathology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, People's Republic of China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing
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Yin T, Peeters R, Feng Y, Liu Y, Yu J, Dymarkowski S, Himmelreich U, Oyen R, Ni Y. Characterization of a rat orthotopic pancreatic head tumor model using three-dimensional and quantitative multi-parametric MRI. NMR IN BIOMEDICINE 2017; 30:e3676. [PMID: 28008670 DOI: 10.1002/nbm.3676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to investigate the reliability of 3D isotropic MRI and quantitative multi-parametric MRI characterization on an orthotopic pancreatic head tumor model in rats. 3D isotropic T2 -weighted MRI was performed as a routine for tumor longitudinal follow-up and volume estimation. Common bile duct diameter was measured from 3D multiplanar reconstruction. Quantitative multi-parametric measurements including pixel-wise T2 , T1 relaxivity, apparent diffusion coefficient (ADC) and apparent diffusion kurtosis mapping were performed twice throughout tumor growth. Semi-quantitative and quantitative analyses based on an extended Tofts model were applied to region-of-interest-based dynamic contrast-enhanced imaging, followed by contrast ratio measurement on standard contrast-enhanced imaging. Moreover, low-level texture-based analysis was inspected for T2 , T1 , ADC and contrast ratio measurements. Results indicated that multi-parametric MRI showed good reproducibility for tumor characterization; the measurements were not affected by tumor growth. Tumor growth was further confirmed with histology examinations. To conclude, state-of-the-art clinical MRI techniques were translated to this preclinical tumor model with high reliability, and have paved the way for translational oncology studies on this tumor model.
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Affiliation(s)
- Ting Yin
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ronald Peeters
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yuanbo Feng
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yewei Liu
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jie Yu
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Steven Dymarkowski
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Uwe Himmelreich
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Raymond Oyen
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yicheng Ni
- Department of Imaging and Pathology, Biomedical Sciences Group, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Zhang TT, Wang L, Liu HH, Zhang CY, Li XM, Lu JP, Wang DB. Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging. Oncotarget 2017; 8:1744-1759. [PMID: 27661003 PMCID: PMC5352094 DOI: 10.18632/oncotarget.12120] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
Differentiation between pancreatic carcinoma (PC) and mass-forming focal pancreatitis (FP) is invariably difficult. For the differential diagnosis, we qualitatively and quantitatively assessed the value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in PC and FP in the present study. This study included 32 PC and 18 FP patients with histological confirmation who underwent DCE-MRI and DWI. The time-signal intensity curve (TIC) of PC and FP were classified into 5 types according to the time of reaching the peak, namely, type I, II, III, IV, and V, respectively, and two subtypes, namely, subtype-a (washout type) and subtype-b (plateau type) according to the part of the TIC profile after the peak. Moreover, the mean and relative apparent diffusion coefficient (ADC) value between PC and FP on DWI were compared. The type V TIC was only recognized in PC group (P < 0.01). Type IV b were more frequently observed in PC (P = 0.036), while type- IIa (P < 0.01), type- Ia (P = 0.037) in FP. We also found a significant difference in the mean and relative ADC value between PC and FP. The combined image set of DCE-MRI and DWI yielded an excellent sensitivity, specificity, and diagnostic accuracy (96.9%, 94.4%, and 96.0%). The TIC of DCE-MRI and ADC value of DWI for pancreatic mass were found to provide reliable information in differentiating PC from FP, and the combination of DCE-MRI and DWI can achieve a higher sensitivity, specificity, and diagnostic accuracy.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Huan-huan Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cai-yuan Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-ming Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-ping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Deng-bin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Crippa S, Partelli S, Belfiori G, Palucci M, Muffatti F, Adamenko O, Cardinali L, Doglioni C, Zamboni G, Falconi M. Management of neuroendocrine carcinomas of the pancreas (WHO G3): A tailored approach between proliferation and morphology. World J Gastroenterol 2016; 22:9944-9953. [PMID: 28018101 PMCID: PMC5143761 DOI: 10.3748/wjg.v22.i45.9944] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine carcinomas (NEC) of the pancreas are defined by a mitotic count > 20 mitoses/10 high power fields and/or Ki67 index > 20%, and included all the tumors previously classified as poorly differentiated endocrine carcinomas. These latter are aggressive malignancies with a high propensity for distant metastases and poor prognosis, and they can be further divided into small- and large-cell subtypes. However in the NEC category are included also neuroendocrine tumors with a well differentiated morphology but ki67 index > 20%. This category is associated with better prognosis and does not significantly respond to cisplatin-based chemotherapy, which represents the gold standard therapeutic approach for poorly differentiated NEC. In this review, the differences between well differentiated and poorly differentiated NEC are discussed considering both pathology, imaging features, treatment and prognostic implications. Diagnostic and therapeutic flowcharts are proposed. The need for a revision of current classification system is stressed being well differentiated NEC a more indolent disease compared to poorly differentiated tumors.
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Choi TW, Lee JM, Kim JH, Yu MH, Han JK, Choi BI. Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions. Korean J Radiol 2016; 17:509-21. [PMID: 27390542 PMCID: PMC4936173 DOI: 10.3348/kjr.2016.17.4.509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/07/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs). MATERIALS AND METHODS 193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis. RESULTS The sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454). CONCLUSION MRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.
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Affiliation(s)
- Tae Won Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Turco S, Wijkstra H, Mischi M. Mathematical Models of Contrast Transport Kinetics for Cancer Diagnostic Imaging: A Review. IEEE Rev Biomed Eng 2016; 9:121-47. [PMID: 27337725 DOI: 10.1109/rbme.2016.2583541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Angiogenesis plays a fundamental role in cancer growth and the formation of metastasis. Novel cancer therapies aimed at inhibiting angiogenic processes and/or disrupting angiogenic tumor vasculature are currently being developed and clinically tested. The need for earlier and improved cancer diagnosis, and for early evaluation and monitoring of therapeutic response to angiogenic treatment, have led to the development of several imaging methods for in vivo noninvasive assessment of angiogenesis. The combination of dynamic contrast-enhanced imaging with mathematical modeling of the contrast agent kinetics enables quantitative assessment of the structural and functional changes in the microvasculature that are associated with tumor angiogenesis. In this paper, we review quantitative imaging of angiogenesis with dynamic contrast-enhanced magnetic resonance imaging, computed tomography, and ultrasound.
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Zabala-Travers S, Choi M, Cheng WC, Badano A. Effect of color visualization and display hardware on the visual assessment of pseudocolor medical images. Med Phys 2016; 42:2942-54. [PMID: 26127048 DOI: 10.1118/1.4921125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Even though the use of color in the interpretation of medical images has increased significantly in recent years, the ad hoc manner in which color is handled and the lack of standard approaches have been associated with suboptimal and inconsistent diagnostic decisions with a negative impact on patient treatment and prognosis. The purpose of this study is to determine if the choice of color scale and display device hardware affects the visual assessment of patterns that have the characteristics of functional medical images. METHODS Perfusion magnetic resonance imaging (MRI) was the basis for designing and performing experiments. Synthetic images resembling brain dynamic-contrast enhanced MRI consisting of scaled mixtures of white, lumpy, and clustered backgrounds were used to assess the performance of a rainbow ("jet"), a heated black-body ("hot"), and a gray ("gray") color scale with display devices of different quality on the detection of small changes in color intensity. The authors used a two-alternative, forced-choice design where readers were presented with 600 pairs of images. Each pair consisted of two images of the same pattern flipped along the vertical axis with a small difference in intensity. Readers were asked to select the image with the highest intensity. Three differences in intensity were tested on four display devices: a medical-grade three-million-pixel display, a consumer-grade monitor, a tablet device, and a phone. RESULTS The estimates of percent correct show that jet outperformed hot and gray in the high and low range of the color scales for all devices with a maximum difference in performance of 18% (confidence intervals: 6%, 30%). Performance with hot was different for high and low intensity, comparable to jet for the high range, and worse than gray for lower intensity values. Similar performance was seen between devices using jet and hot, while gray performance was better for handheld devices. Time of performance was shorter with jet. CONCLUSIONS Our findings demonstrate that the choice of color scale and display hardware affects the visual comparative analysis of pseudocolor images. Follow-up studies in clinical settings are being considered to confirm the results with patient images.
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Affiliation(s)
- Silvina Zabala-Travers
- Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993
| | - Mina Choi
- Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993
| | - Wei-Chung Cheng
- Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993
| | - Aldo Badano
- Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993
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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: 17] [Impact Index Per Article: 2.1] [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: 3.0] [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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Feasibility of test-bolus DCE-MRI using CAIPIRINHA-VIBE for the evaluation of pancreatic malignancies. Eur Radiol 2016; 26:3949-3956. [PMID: 26809293 DOI: 10.1007/s00330-016-4209-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/25/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the feasibility of test-bolus dynamic contrast-enhanced (DCE) MRI with CAIPIRINHA-VIBE for pancreatic malignancies. METHODS Thirty-two patients underwent DCE-MRI with CAIPIRINHA-VIBE after injection of 2 mL gadolinium. From the resulting time-intensity curve (TIC), we estimated the arterial (AP) and portal venous phase (PVP) scan timing for subsequent multiphasic MRI. DCE-MRI perfusion maps were generated, and perfusion parameters were calculated. The image quality was rated on a 5-point scale (1: poor, 5: excellent). Goodness-of-fit of the TIC was evaluated by Pearson's χ2 test. RESULTS Test-bolus DCE-MRIs with high temporal (3 s) and spatial resolution (1 × 1 × 4 mm3) were acquired with good-quality perfusion maps of Ktrans and iAUC (mean score 4.313 ± 0.535 and 4.125 ± 0.554, respectively). The mean χ2 values for fitted TICs were 0.115 ± 0.082 for the pancreatic parenchyma and 0.784 ± 0.074 for pancreatic malignancies, indicating an acceptable goodness-of-fit. Test-bolus DCE-MRI was highly accurate in estimating the proper timing of AP (90.6 %) and PVP (100 %) of subsequent multiphasic MRI. Between pancreatic adenocarcinomas and neuroendocrine tumours, there were significant differences in the Ktrans (0.073 ± 0.058 vs. 0.308 ± 0.062, respectively; p = 0.007) and iAUC (1.501 ± 0.828 vs. 3.378 ± 0.378, respectively; p = 0.045). CONCLUSIONS Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for incorporating perfusion analysis of pancreatic tumours into routine multiphasic MRI. KEY POINTS • Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for perfusion analysis of pancreatic tumours. • CAIPIRINHA-VIBE enables DCE-MRI with high temporal and spatial resolution. • Test-bolus DCE-MRI is highly accurate in estimating the proper timing of multiphasic MRI.
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Multiparametric fully-integrated 18-FDG PET/MRI of advanced gastric cancer for prediction of chemotherapy response: a preliminary study. Eur Radiol 2015; 26:2771-8. [DOI: 10.1007/s00330-015-4105-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/20/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023]
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Correlation of Histological Vessel Characteristics and Diffusion-Weighted Imaging Intravoxel Incoherent Motion–Derived Parameters in Pancreatic Ductal Adenocarcinomas and Pancreatic Neuroendocrine Tumors. Invest Radiol 2015; 50:792-7. [DOI: 10.1097/rli.0000000000000187] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wu L, Lv P, Zhang H, Fu C, Yao X, Wang C, Zeng M, Li Y, Wang X. Dynamic contrast-enhanced (DCE) MRI assessment of microvascular characteristics in the murine orthotopic pancreatic cancer model. Magn Reson Imaging 2015; 33:737-60. [DOI: 10.1016/j.mri.2014.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 07/12/2014] [Accepted: 08/10/2014] [Indexed: 11/29/2022]
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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: 1.8] [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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