Can preoperative liver MRI with gadoxetic acid help reduce open-close laparotomies for curative intent pancreatic cancer surgery?

Abstract

Objectives To evaluate gadoxetic acid-enhanced liver MRI (EOB-MRI) versus contrast-enhanced computed tomography (CECT) for preoperative detection of liver metastasis (LM) and reduction of open-close laparotomies for pancreatic ductal adenocarcinoma (PDAC). Methods Sixty-six patients with PDAC had undergone preoperative EOB-MRI and CECT. LM detection by EOB-MRI and CECT and their impact on surgical planning, open-close laparotomies were compared by clinical and radiology reports and retrospective analysis of imaging by two blinded independent readers. Histopathology or imaging follow-up was the reference standard. Statistical analysis was performed at patient and lesion levels with two-sided McNemar tests. Results EOB-MRI showed higher sensitivity versus CECT (71.7% [62.1-80.0] vs. 34% [25.0-43.8]; p = 0.009), comparable specificity (98.6%, [96.9-99.5] vs. 100%, [99.1-100], and higher AUROC (85.1%, [80.4-89.9] vs. 66.9%, [60.9-73.1]) for LM detection. An incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6% in futile open-close laparotomies due to LM detected on EOB-MRI only. Conclusions Preoperative EOB-MRI has superior diagnostic performance in detecting LM from PDAC. This better informs surgical eligibility with potential reduction of futile open-close laparotomies from attempted curative intent pancreatic cancer surgery.

Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics

“…MRI and CT show similar performance in the presurgical evaluation of pancreatic cancer [386,387]. Preoperative MRI is instrumental to detect the stage and resectability of pancreatic cancer [388] and preoperative gadoxetic acid-enhanced liver MRI has a high diagnostic performance in detecting liver metastasis from pancreatic ductal adenocarcinoma [389,390]. Gadolinium-enhanced MRI with DWI detected synchronous liver metastases [391], whereas [F-18]-FDG PET/MRI provides an imaging tool to improve the staging of pancreatic cancer and for the identification of Sister Mary Joseph nodules [392].…”

Efficacy of Staging Laparoscopy in Patients With Pancreatic Cancer: A Single Center Prospective Cohort Study

“…Multimodality imaging is critical in the diagnosis and staging of PC with triple-phase helical CT being the best-validated and most widely available modality. MRI or FDG-PET was not routinely performed in previous studies, although it has been reported that EOB-MRI and FDG-PET have superior diagnostic performance in detecting distant metastasis from PC (12,13). NCCN guidelines suggest that MRI or FDG-PET can be considered a helpful adjunct modality in highrisk patients of metastatic disease, such as those with borderline resectable disease, markedly elevated CA19-9, large primary tumors, or large regional nodes (14).…”

Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine

“…A CT structured reporting template for PDAC should include assessment of the following items (Figure 2 In regard to liver metastases, preoperative MRI, especially diffusion weighted imaging, has been found to depict synchronous small liver metastases that are undetectable with standard workup CT in approximately 10-24% of patients; this improvement in the detection of liver metastases may change patient management with decrease in the rate of unnecessary laparotomy and pancreatectomy [31][32][33].…”