Pancreatic adenocarcinoma: MRI conspicuity and pathologic correlations

Legrand, Laurence; Duchatelle, V.; Molinié, Vincent; Boulay-Coletta, I.; Sibileau, É.; Zins, Marc

doi:10.1007/s00261-014-0196-8

Cited by 42 publications

(33 citation statements)

References 37 publications

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“…It must, however, be noted that in some instances the coexistence of chronic pancreatitis might lead to the relative preservation of the MR signal of the peritumoral pancreatic parenchyma on high-b-value DW images, thus leading to a decrease in the signal intensity ratio between the pancreas and the PanNEN [27]. As this could represent a possible source of false-negative results in DWI, patients with chronic pancreatitis must be examined with particular caution; probably, fsT2w images and the evaluation of secondary signs, such as deformation of the pancreatic contour or MPD/CBD dilation, might help in the precise localization of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

et al. 2015

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Background/Aims: Diffusion-weighted imaging (DWI) can depict random motions of water molecules in biological tissues during magnetic resonance (MR) examinations. Few papers have tested its application to pancreatic neuroendocrine neoplasms (PanNENs). The aim of this paper is to assess the clinical value of DWI regarding the identification and characterization of PanNENs and diagnosis of liver metastases. Methods: Preoperative MR examinations of 30 PanNEN patients were retrospectively reviewed; 30 patients with pathologically proven pancreatic ductal adenocarcinoma (PDAC) were included to compare the imaging features. Qualitative and quantitative MR features were compared between histotypes. A blinded-reader comparison of diagnostic confidence for PanNENs and liver metastases was conducted on randomized image sets. All results were compared with pathological data. Results: PanNEN conspicuity was higher on DW images compared to conventional MR sequences. DWI had higher detection rates for PanNENs than had conventional sequences (93.3 vs. 71.1%). Sharp margins and absence of main pancreatic duct/common bile duct dilation and chronic pancreatitis were more common among PanNENs as compared to PDACs. Arterial iso- or hyperenhancement and portal hyperenhancement were more frequent within PanNENs as compared to PDACs. No differences between histotypes were found for quantitative features. Arterial-phase images had the highest interobserver agreement for the diagnosis of PanNEN (Cohen's κ = 0.667). DWI provided the highest detection rate for liver metastases as well as excellent interobserver agreement for the diagnosis of liver metastases (κ = 0.932), with good accuracy (AUC = 0.879-0.869). Conclusion: DWI has clinical value regarding the identification of PanNENs and the diagnosis of liver metastases, while conventional MR sequences are fundamental for their characterization.

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Section: Discussionmentioning

confidence: 99%

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

et al. 2015

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“…Surgical resection is the only curative treatment for this neoplasm, therefore the preoperative prediction of the pathological grade may have a smaller importance for PDAC management as compared to other pancreatic tumors. Some studies have tried to correlate DWI findings with the pathological grade, but results are controversial [43][44][45] . Details on the most relevant published studies are reported in Table 2.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

“…Details on the most relevant published studies are reported in Table 2. Overall, low-grade PDACs tend to present low ADC values [43][44][45] , but it still not clear which histological feature mainly contributes to diffusion restriction. Wang et al [43] and Muraoka et al [46] reported that tumors with limited glandular formation and dense fibrosis (i.e., paucicellular tumors) had lower ADC values as compared to welldifferentiated lesions characterized by neoplastic tubular structures; moreover, PDACs with dense fibrosis showed significantly lower ADC values than those with loose fibrosis.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

“…Perfusion imaging techniques [24] 99 0, 500 1.29 (WD); 1.22 (MD); 1.21 (PD) Saito et al [25] 32 100, 800 1.25 (WD); 1.12 (MD); 1.13 (PD) Muhi et al [26] 73 500, 800 0.91 (WD); 0.71 (MD); 0.68 (PD) Nishie et al [27] 80 0, 500, 1000 1.21 (WD); 1.14 (MD); 0.76 (PD) Heo et al [28] 27 0, 1000 1.20 (WD); 1.10 (MD); 0.90 (PD) Nakanishi et al [29] 44 0, 50, 1000 might provide more structural limitations than fibrosis alone. Legrand et al [44] reported that mean ADC values did not significantly differ between tumors having < 50% and those having > 50% of fibrotic stroma, or between tumors containing dense fibrosis and those containing loose fibrosis. Similarly, Rosenkrantz et al [45] reported no associations between ADC values and "adverse" pathological features as poor differentiation.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

“…Etchebehere et al [67] compared WBDWI with 68 Ga-DOTATATE PET-CT and 99mTc-HYNICOctreotide SPECT-CT: WBDWI had a similar accuracy when compared to molecular imaging techniques for lung and liver lesions, while showed a higher false-negative rate for bone lesions. Schraml et al [68] reported that PET-CT and WBDWI had comparable overall detection rates for NETs metastases but Wang et al [43] 21 0, 500 PDAC 2.10 (WD-MD); 1.46 (PD) Legrand et al [44] 22 Wang et al [58] 18 0, 50, 500 PanNET 1.75 (G1); 1.00 (G3) Jang et al [59] 20 0, 800 PanNET 1.48 (G1-G2); 1.04 (G3) Hwang et al [60] 44 significantly differed in organ-based detection rates with superiority of PET-CT for lymph node and pulmonary lesions and of WBDWI for liver and bone metastases. Experimental applications of pCT to PanNETs reported interesting results.…”

Section: Pancreatic Tumorsmentioning

confidence: 99%

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Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Robertis¹,

Martini²,

Demozzi³

et al. 2015

WJG

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Diffusion-weighted imaging (DWI), dynamic contrastenhanced 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 posttreatment assessment, even at an early stage. or altered cellular membranes will present diffusion restriction, which is depicted as signal hyperintensity areas on high b-value DW images and hypointensity on the apparent diffusion coefficient (ADC) maps; ADC measurement can also quantify water molecules' diffusion. As dedifferentiation or therapies may induce microscopic changes in neoplastic tissues that could modify water molecules' diffusion, DWI can distinguish between different degrees of malignancy and can be also proposed for post-treatment monitoring. Moreover, DWI can be performed in a single session with DCE-MRI, thus providing a comprehensive "one-step" morphological and functional evaluation of hepatobilio-pancreatic tumors.Perfusion imaging techniques evaluate changes in signal intensity (DCE-MRI) or density (pCT) after contrast medium injection, being therefore able to assess microvascularization through the evaluation of the dynamics of contrast medium distribution from vessels to the neoplastic tissue. Perfusion parameters are therefore theoretically good candidates for the evaluation of microscopic vascular differences between lesions with different pathological grade and for the assessment of treatment response, especially after chemoembolization or during treatments with antiangiogenic drugs.This editorial analyzes up-to-date literature data regarding the application of functional imaging techniques, apart from molecular imaging, to hepatic and pancreatic tumors, with particular emphasis on correlations to pathological features, prognostic stratification and therapeutic response assessment. FUNCTIONAL IMAGING TECHNIQUES: TECHNICAL BASESIn 1965 Stejskal and Tanne...

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Radiologic Diagnosis of Pancreatic Cancer

Recht

Fishman

2023

The Pancreas

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Pancreatic adenocarcinoma: MRI conspicuity and pathologic correlations

Abstract: 3D FS T1 GRE arterial phase imaging produces greater pancreatic adenocarcinoma conspicuity compared to DWI but underestimates tumor size. DWI provides the best size evaluation but fails to delineate the tumor in one-fourth of cases.

Cited by 42 publications

References 37 publications

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

Pancreatic Neuroendocrine Neoplasms: Clinical Value of Diffusion-Weighted Imaging

Prognostication and response assessment in liver and pancreatic tumors: The new imaging

Radiologic Diagnosis of Pancreatic Cancer

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