Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma

Rong, Dailin; Mao, Yijun; Hu, Wanming; Xu, Shuhang; Wang, Jun; He, Hualiang; Li, Shengping; Zhang, Rong

doi:10.1007/s00330-017-5259-0

Cited by 13 publications

(11 citation statements)

References 38 publications

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“…The aggressive biological behavior of tumors may be associated with the difference in tumor microstructure. Our results suggested that MD of the tumor with LNM had a lower MD value, which is consistent with most previous studies on pancreatic cancer and cholangiocarcinoma [13,24,28].…”

Section: Discussionsupporting

confidence: 93%

“…MRI with diffusion-weighted imaging (DWI) can be used to noninvasively assess the pancreatic tumor, neighboring soft tissues, microvascular invasion, water diffusion behavior, and LNM in one examination [11]. Several studies have reported positive results for identifying metastatic lymph nodes in pancreatic tumors through the use of MRI findings, apparent diffusion coefficient (ADC), and intravoxel incoherent motion (IVIM) [11][12][13]. It is possible that MRI with DWI might show differences in morphology, water diffusion, heterogeneity, and microenvironment characteristics among metastatic and non-metastatic for small lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

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Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Shi

Liu

et al. 2021

Abdom Radiol

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Purpose To evaluate the potential role of MR findings and DWI parameters in predicting small regional lymph nodes metastases (with short-axis diameter < 10 mm) in pancreatic ductal adenocarcinomas (PDACs). Methods A total of 127 patients, 82 in training group and 45 in testing group, with histopathologically diagnosed PDACs who underwent pancreatectomy were retrospectively analyzed. PDACs were divided into two groups of positive and negative lymph node metastases (LNM) based on the pathological results. Pancreatic cancer characteristics, short axis of largest lymph node, and DWI parameters of PDACs were evaluated. Results Univariate and multivariate analyses showed that extrapancreatic distance of tumor invasion, short-axis diameter of the largest lymph node, and mean diffusivity of tumor were independently associated with small LNM in patients with PDACs. The combining MRI diagnostic model yielded AUCs of 0.836 and 0.873, and accuracies of 81.7% and 80% in the training and testing groups. The AUC of the MRI model for predicting LNM was higher than that of subjective MRI diagnosis in the training group (rater 1, P = 0.01; rater 2, 0.008) and in a testing group (rater 1, P = 0.036; rater 2, 0.024). Comparing the subjective diagnosis, the error rate of the MRI model was decreased. The defined LNM-positive group by the MRI model showed significantly inferior overall survival compared to the negative group (P = 0.006). Conclusions The MRI model showed excellent performance for individualized and noninvasive prediction of small regional LNM in PDACs. It may be used to identify PDACs with small LNM and contribute to determining an appropriate treatment strategy for PDACs.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Shi

Liu

et al. 2021

Abdom Radiol

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“…35 Recent studies using nomograms based on radiographic features of contrastenhanced CT scans demonstrate promising rates of positive lymph node identification in both the test and validation cohorts. 36,37 With similar advances in progress using abdominal MRIs 38 and based on the aforementioned implications of an elevated lymph node positive ratio on early disease recurrence demonstrated in our analysis, improving imaging modalities may facilitate more judicious patient selection for surgery following NAT.…”

Section: Discussionmentioning

confidence: 58%

Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma

Narayanan

AlMasri

Zenati

et al. 2021

Journal of Surgical Oncology

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Background and Objectives: Neoadjuvant chemotherapy (NAT) for pancreatic adenocarcinoma (PDAC) is increasingly being utilized. However, a significant number of patients will experience early recurrence, possibly negating the benefit of surgery. We aimed to identify factors implicated in early disease recurrence.Methods: A retrospective review of pancreaticoduodenectomies performed between 2005 and 2017 at our institution for PDAC following NAT was performed.A 6-month cut-off was used to stratify patients into early/late recurrence groups.Multivariate analysis was performed to identify predictors of recurrence.Results: Of 273 patients, 64 (23%) developed early recurrence or died within 90 days of surgery. The median time to recurrence was 4 months (95% confidence interval [CI]: 2.2-4.3) in the early group versus 16 months (95% CI: 13.7-19.9) in the late group. The former had higher baseline and post-NAT Ca19-9 levels than the latter (472 vs. 153 IU/ml, p = 0.001 and 71 vs. 39 IU/ml, p = 0.005, respectively).A higher positive lymph node ratio significantly increased the risk of early recurrence (hazard ratio [HR]: 15.9, p < 0.001) while adjuvant chemotherapy was protective (HR: 0.4, p < 0.001). Conclusion:Our findings acknowledge the limitations of clinically measured factors used to ascertain response to NAT and underline the need for individualized molecular markers that take into consideration the specific tumor biology.

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“…For the pelvic lymph nodes in prostate cancer (including a small group of a bladder cancer patients in one study) from 910 to 1430 × 10 -6 mm 2 /s [27,[39][40][41]. For the abdominal lymph nodes in biliary carcinomas 1800 × 10 -6 mm 2 /s 37 or in pancreatic ductal adenocarcinoma 1390 × 10 -6 mm 2 /s [38]. For the axillary lymph nodes in breast cancer from 812 to 1300 × 10 -6 mm 2 /s [26,[43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

Białek¹,

Małkowski

2020

Nuklearmedizin

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Aim To check if diffusion weighted imaging (DWI) might be helpful in proper recognition of celiac (CG) and cervicothoracic (CTG) sympathetic ganglia on the whole-body multimodal PSMA-ligand PET/MR imaging, in the view of their common misleading avidity on PET potentially suggestive of malignant lesions, including metastatic lymph nodes. Methods The thickness and the level of diffusion restriction was assessed qualitatively and quantitatively in 406 sympathetic ganglia (189 CTG in 101 males and 217 CG in 116 males) on DWI maps (b-value 0 and 800 s/mm2) and apparent diffusion coefficient (ADC) maps (mean ADC) of the whole-body PET/MR 68Ga-PSMA-11 PET/MR. To form a reference group of a matching ganglia size, the smallest lymph node was chosen from each patient with metastases and underwent the same procedure. Results Very low and low level of diffusion restriction was noted in the majority of sympathetic ganglia (81.0 % CTG, 67.3 % CG, and 73.6 % of all). In the majority (91.7 %) of metastatic lymph nodes the level of diffusion restriction was moderate to high.The mean ADC values in sympathetic ganglia were statistically significantly higher in CTG, CG and all ganglia than in metastatic lymph nodes (p < 0.001; the effect size was large). Conclusions Sympathetic celiac and cervicothoracic ganglia present very low and low level of diffusion restriction in visual DWI assessment, and significantly higher than metastatic lymph nodes mean ADC values in the majority of cases, which may serve as additional factors aiding differential diagnosis on multimodal PSMA-ligand PET/MR imaging.Therefore, PSMA-ligand PET/MR appears potentially superior to PSMA-ligand PET/CT in proper identification of sympathetic ganglia.

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Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma

Abstract: • IVIM DWI is feasible for diagnosing LN metastasis in PDAC. • Metastatic LNS has lower D, D, f, ADC values than non-metastatic LNS. • D-value from IVIM model has best diagnostic performance, followed by ADC value. • D has the lowest AUC value.

Cited by 13 publications

References 38 publications

Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

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Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma

Abstract: • IVIM DWI is feasible for diagnosing LN metastasis in PDAC. • Metastatic LNS has lower D, D*, f, ADC values than non-metastatic LNS. • D-value from IVIM model has best diagnostic performance, followed by ADC value. • D* has the lowest AUC value.

Cited by 13 publications

References 38 publications

Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Establishment of a multi-parameters MRI model for predicting small lymph nodes metastases (<10 mm) in patients with resected pancreatic ductal adenocarcinoma

Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

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Abstract: • IVIM DWI is feasible for diagnosing LN metastasis in PDAC. • Metastatic LNS has lower D, D, f, ADC values than non-metastatic LNS. • D-value from IVIM model has best diagnostic performance, followed by ADC value. • D has the lowest AUC value.