Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT

Gaddam

Magnetic Resonance in Med

et al. 2020

Purpose: To develop a quantitative DCE MRI technique enabling entire-abdomen coverage, free-breathing acquisition, 1-second temporal resolution, and T 1 -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 T 1 recovery dimension for dynamic T 1 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 v p , K trans , v e , and K ep were evaluated for each subject. Intersession repeatability of Multitasking DCE was assessed in 8 repeat healthy subjects. One-way unbalanced analysis of variance (ANOVA) was performed between control and patient groups. Results:In vivo studies demonstrated that v p , K trans , and K ep 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 v e was significantly higher than nontumoral regions (P < .001) and healthy pancreas (P < .001). The kinetic parameters showed good in vivo repeatability (interclass correlation coefficient: v p , 0.95; K trans , 0.98; v e , 0.96; K ep , 0.99). | 929 WANG et Al. How to cite this article: Wang N, Gaddam S, Wang L, et al. Six-dimensional quantitative DCE MR Multitasking of the entire abdomen: Method and application to pancreatic ductal adenocarcinoma. Magn Reson Med. 2020;84:928-942.

Section: Introductionmentioning

confidence: 99%

Six‐dimensional quantitative DCE MR Multitasking of the entire abdomen: Method and application to pancreatic ductal adenocarcinoma

Gaddam

Magnetic Resonance in Med

et al. 2020

“…overall 5-year survival rate of approximately 5%. 64 Over the past 25 years, the radiologist's ability to diagnose pancreatic cancer has improved enormously due to the development of cross-sectional imaging techniques such as ultrasound and especially MDCT, with its capability for 3D imaging. MRI is therefore usually not routinely indicated in patients with pancreatic cancer.…”

mentioning

confidence: 99%

“…MRI can provide a definitive diagnosis in patients with equivocal findings at ultrasound and/or CT as to the presence or absence of a tumor; it also helps providing a correct staging of the cancer in critical cases, which may help reduce the number of unnecessary laparatomies; it may also aid to differentiate cancer cases from patients with focal pancreatitis, which can often be managed conservatively. 64 On unenhanced MRI, small tumors are best detected on T1-weighted breath-hold fat-suppressed gradient recalled echo (GRE) images as hypointense masses. If the tumor involves the peri-pancreatic tissues, fat-suppressed T1-weighted GRE images show a lack of contrast between the low tumor signal intensity and the suppressed background fat signal; therefore, the acquisition of T1-weighted GRE images without fat suppression is also advisable.…”

mentioning

confidence: 99%

“…Liver-specific agents also provide an accurate regional staging of pancreatic cancer. In a series of 105 patients studied with mangafodipir-enhanced MRI, Schima et al 64 have reported a diagnostic accuracy of over 90% for local staging of the disease. The authors concluded that mangafodipir trisodium is a versatile contrast agent for pancreas MRI as it increases the reader's confidence in the detection or exclusion of small pancreatic tumors in patients with equivocal CT findings.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Mangafodipir trisodium: review of its use as an injectable contrast medium for magnetic resonance imaging

Regge¹,

Cirillo²,

Macera³

et al. 2009

RMI

Mangafodipir trisodium is a hepatobiliary contrast agent, taken up by the hepatocytes and largely excreted via the bile ducts. The agent increases the signal intensity of the normal liver, and to a lesser extent of the pancreas, adrenal glands, kidneys and myocardium, on T1-weighted imaging. The increase of the signal intensity on the T1 images allows better visualization of focal lesions, especially of those that are of non-hepatocitary origin such as metastases. For this reason the most important indication for the use of mangafodipir trisodium is in detecting liver metastases, especially when the information may influence therapeutic planning, which in many cases is surgical resection. New data show that this liver-specific contrast agent is accurate in detecting small lesions and in assessing the liver status following neoadjuvant chemotherapy, where other imaging techniques, such as CT and PET, fail. Other lesser indications for studies with mangafodipir trisodium are: in characterizing liver and pancreatic lesions; in identifying biliary leakage following bile duct and/or liver surgery; and possibly in the future in the assessment of the extent of myocardial damage.

“…In clinical practice, among the widely used imaging tools applied to pancreatic cancer preoperative staging and resectability evaluation, magnetic resonance imaging (MRI) is commonly used due to its high soft tissue resolution, which can increase the discrimination of the cancer nidus and provide an advantage in the detection of smaller lesions (10). Dynamic contrast-enhanced MRI (DCE-MRI) makes a difference in the detection and staging of pancreatic cancer (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging for preoperative staging of pancreatic cancer based on the 8th edition of AJCC guidelines

Deng

Ming

et al. 2020

J Gastrointest Oncol

Background: Preoperative staging of pancreatic cancer determines the choice of treatment. Magnetic resonance imaging (MRI) plays an important role in preoperative staging of pancreatic cancer. The American Joint Committee on Cancer (AJCC) TNM staging system was revised to its 8 th version in 2016, there has been no report correlating the 8 th edition of the AJCC TNM staging with preoperative MRI examinations and pathological findings. The purpose of our study is to determine the staging accuracy and evaluate the resectability by using MRI about pancreatic cancer compared with intraoperative or pathological findings according to the 8 th edition of the AJCC TNM staging system.Methods: One hundred thirty-two patients with a pathological diagnosis of pancreatic cancer who underwent preoperative MRI were identified. The clinical data, MRI findings and pathological findings were analyzed. Preoperative MRI staging and resectability evaluation were compared with pathological findings.The accuracy of MRI for preoperative T and N staging was evaluated, and the sensitivity, specificity and accuracy of MRI in evaluating the resectability were assessed. All the staging and resectability assessments were according to the 8 th edition of the AJCC TNM staging system.Results: Analysis showed that the accuracy of MRI for evaluation of the T and N stages was 82.6% (109/132) and 74.2% (98/132), respectively. The sensitivity and specificity of MRI in assessing the resectability were 94.2% and 71.4%, respectively. Integrating the 8 th edition of the AJCC TNM stage, no significant differences were identified between the preoperative MRI and pathological results for the staging of pancreatic cancer (P=0.805).Conclusions: MRI is highly accurate for T staging and moderately accurate for N staging. MRI provides important preoperative evaluation of the stage and resectability of pancreatic cancer based on the 8 th edition of the AJCC TNM staging system.