Improving preoperative detection of synchronous liver metastases in pancreatic cancer with combined contrast-enhanced and diffusion-weighted MRI

Abstract

Purpose To explore the value of gadolinium-enhanced MRI combined with diffusion-weighted MRI (Gd-enhanced MRI with DWI) in addition to contrast-enhanced CT (CECT) for detection of synchronous liver metastases for potentially resectable pancreatic cancer. Methods By means of a retrospective cohort study we included patients with potentially resectable pancreatic cancer on CECT, who underwent Gd-enhanced MRI with DWI between January 2012 and December 2016. A single observer evaluated MRI and CT and was blinded to imaging, pathology, and surgery reports. Liver lesions were scored in both modalities, using a 3-point scale: 1-benign, 2-indeterminate, 3-malignant (i.e., metastasis). The primary outcome parameters were the presence of liver metastases on Gd-enhanced MRI with DWI and the sensitivity of Gd-enhanced MRI with DWI for synchronous liver metastases. Results We included 66 patients (42 men, 24 women; median age 65 years, range 36-82 years). In 19 patients, liver metastases were present, which were confirmed by histopathology (n = 12), 18 FDG-PET (n = 6), or surgical inspection (n = 1). Gd-enhanced MRI with DWI showed metastases in 16/19 patients (24%), which resulted in a sensitivity of 84% (95% CI 60-97%). Contrast-enhanced MRI showed 156 and DWI 397 metastases (p = 0.051), and 339 were particularly small (\ 5 mm). Conclusions In this study, Gd-enhanced MRI with DWI detected synchronous liver metastases in 24% of patients with potentially resectable pancreatic cancer on CECT with a sensitivity of 84%. Diffusion-weighted MRI showed a greater number of metastases than any other sequence, particularly small metastases (\ 5 mm).

Diagnostic accuracy of contrast-enhanced diffusion-weighted MRI for liver metastases of pancreatic cancer: towards adequate staging and follow-up of pancreatic cancer – DIA-PANC study: study protocol for an international, multicenter, diagnostic trial

“…Most studies that have been performed for liver metastases of PDAC are retrospective, including our single center study in patients with potentially resectable pancreatic cancer without liver metastases on CECT [25]. In this study Gadolinium (Gd) enhanced MRI with DWI detected synchronous liver metastases in 24% of patients with potentially resectable pancreatic cancer on CECT with a sensitivity of 84%.…”

“…The sample size is calculated based on a method for power calculations for diagnostic studies described by Jones et al [30]. Based on literature and our previously performed retrospective study [9,[31][32][33][34][35] we estimate the sensitivity of MRI will be approximately 90%. In literature the specificity for MRI is usually higher than the sensitivity, therefore we based our sample size calculation on the sensitivity only.…”

MRI-guided percutaneous thermoablation in combination with hepatic resection as parenchyma-sparing approach in patients with primary and secondary hepatic malignancies: single center long-term experience

“…A further advantage of MRI as guidance modality is the high sensitivity in detection of small liver lesions [28]. Several studies have shown that MRI has a higher sensitivity in detection of small liver lesions in comparison to CT, so that preoperative acquisition of hepatic MRI can lead to a significant change in the treatment plan [29]. In four of our study patients, planning imaging at the beginning of the intervention revealed six new and therefore suspicious lesions, which could be successfully treated in the same procedure.…”

Metastatic pancreatic cancer: Mechanisms and detection (Review)

“…As mentioned above, combinations of CT modalities have improved its efficacy to a large extent. Likewise, combining diffusion-weighted MRI with CE-MRI has nearly doubled the early detection of liver metastasis (from 156 to 397 cases) ( 40 ).…”