Determination of vascular involvement and resectability in locally advanced and (borderline) resectable pancreatic cancer using intra-operative ultrasound – A prospective multicenter study

Michiels, Nynke; Doppenberg, Deesje; Groen, Jesse V.; Bonsing, Bert A.; Busch, Olivier R.; Crobach, Stijn; Delden, Otto van; Sarasqueta, Arantza Farina; Hingh, Ignace de; Hurks, Rob; Feshtali, Shirin; Tank, Yeliz; Veldhuisen, Eran van; Wasser, Martin; Besselink, Marc G.; Mieog, S.

doi:10.1016/j.ejso.2021.12.236

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“…Until the role of CE-MRI is validated, the above-mentioned CT criteria might support the anatomical restaging with CE-CT scan. Additionally, patient selection could be further improved by implementing the use of PET combined with CT or MRI before and after induction chemo(radio)therapy for local response evaluation [ 8 , 39 , 48 ] and intraoperative ultrasonography during an exploratory laparotomy to assess the (extent of) vascular tumor involvement [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Added value of 3T MRI and the MRI-halo sign in assessing resectability of locally advanced pancreatic cancer following induction chemotherapy (IMAGE-MRI): prospective pilot study

Stoop

Veldhuisen²,

Rijssen³

et al. 2022

Langenbecks Arch Surg

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Background Restaging of locally advanced pancreatic cancer (LAPC) after induction chemotherapy using contrast-enhanced computed tomography (CE-CT) imaging is imprecise in evaluating local tumor response. This study explored the value of 3 Tesla (3 T) contrast-enhanced (CE) and diffusion-weighted (DWI) magnetic resonance imaging (MRI) for local tumor restaging. Methods This is a prospective pilot study including 20 consecutive patients with LAPC with RECIST non-progressive disease on CE-CT after induction chemotherapy. Restaging CE-CT, CE-MRI, and DWI-MRI were retrospectively evaluated by two abdominal radiologists in consensus, scoring tumor size and vascular involvement. A halo sign was defined as replacement of solid perivascular (arterial and venous) tumor tissue by a zone of fatty-like signal intensity. Results Adequate MRI was obtained in 19 patients with LAPC after induction chemotherapy. Tumor diameter was non-significantly smaller on CE-MRI compared to CE-CT (26 mm vs. 30 mm; p = 0.073). An MRI-halo sign was seen on CE-MRI in 52.6% (n = 10/19), whereas a CT-halo sign was seen in 10.5% (n = 2/19) of patients (p = 0.016). An MRI-halo sign was not associated with resection rate (60.0% vs. 62.5%; p = 1.000). In the resection cohort, patients with an MRI-halo sign had a non-significant increased R0 resection rate as compared to patients without an MRI-halo sign (66.7% vs. 20.0%; p = 0.242). Positive and negative predictive values of the CE-MRI-halo sign for R0 resection were 66.7% and 66.7%, respectively. Conclusions 3 T CE-MRI and the MRI-halo sign might be helpful to assess the effect of induction chemotherapy in patients with LAPC, but its diagnostic accuracy has to be evaluated in larger series.

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