Preoperative CT staging of borderline pancreatic cancer patients after neoadjuvant treatment: accuracy in the prediction of vascular invasion and resectability

Ahmed, Shaimaa; Mourad, Amr F.; Hassan, Ramy A.; Ibrahim, Mohamed Abd Elsalam; Soliman, Ahmed; Aboeleuon, Ebrahim; Elbadee, Osama Mostafa Abd; Hetta, Helal F; Jabir, Murad A.

doi:10.1007/s00261-020-02605-4

Cited by 14 publications

(8 citation statements)

References 34 publications

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“…Meta-analysis demonstrated a higher diagnostic accuracy to predict R0 resection when using the modified criteria (0.78 [95% CI 0.74–0.82] versus 0.67 [95% CI 0.63–0.71]) [ 15 ]. Ahmed and colleagues showed that more detailed criteria involving the degree and length of involvement and vessel deformation are reproducible and sufficient predictors for R0 resection [ 31 , 43 ]. In addition to such modified criteria, the change of tumor attenuation on CE-CT scan may be useful to predict R0 resection [ 44 ] as well as the tumor homogeneity that seems to correlate with disease-free and overall survival [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the case of portomesenteric venous involvement, the length of tumor involvement in millimeters was used if the degree of involvement was similar on CT scan and MRI. This strategy to use of the degrees and length of vascular tumor involvement is derived from the classification from Ahmed and colleagues [ 31 ]. If multiple major vessels were involved whereby one vessel showed more involvement on one of the imaging modalities whereas the other vessel had less involvement, the number of vessels and the length of portomesenteric venous involvement were used for the categorization into decreased , stable , and increased vascular involvement.…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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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“…일부 연구자들은 선행 보조 치료 후 절제 가능성을 평가하는 새로운 영상 기준을 제시하였다. 종양과 주요 혈관 (SMA, SMV 및 PV)의 접촉이 변화 없거나 일부 감소하는 경우( 81 82 ), 선행 보조 치료 후 NCCN 가이드라인의 경계절제성의 진단기준을 만족시키는 경우( 83 ), 혈관과 접하는 각도, 길이 및 혈관의 변형을 함께 고려하는 경우( 84 ), 혹은 개별 혈관을 평가하는 것이 아니라 전반적인 판독자의 판단에 따라 결정하는 경우( 85 ), NCCN 가이드라인 등 기존의 기준을 이용하는 것보다 절제 가능성을 더 정확히 평가할 수 있다고 보고되었다. 메타 분석에서, 선행 보조 치료 후에 기존 가이드라인의 기준을 사용하는 경우 CT의 절제 가능성을 진단하는 민감도와 특이도는 각각 45%(95% 신뢰구간 19~73) 및 85%(95% 신뢰구간 65~94)로, 민감도가 낮다( 86 ).…”

Section: 수술 전 선행 보조 치료unclassified

Radiologic Evaluation for Resectability of Pancreatic Adenocarcinoma

황

박

2021

J Korean Soc Radiol

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췌장 선암의 발견, 진단, 절제 가능성 평가, 병기 설정 및 치료 방침 결정에 영상 검사는 중요한 역할을 담당하고 있다. 최근에는 진단 당시 경계절제성 혹은 국소 진행성 췌장암을 진단 받은 경우 선행 보조 치료 또는 완화 치료 후 가능하면 근치적 절제술을 고려할 것이 권고된다. 이 종설에서는 췌장 선암의 절제 가능성 평가, 원격 전이의 진단 및 선행 보조 치료 또는 완화 치료 후 절제 가능성을 재평가할 때 영상 검사의 해석, 판독 기준 및 고려할 사항에 대하여 설명하고자 한다.

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“…Recent research has focused on predicting vascular invasion in tumors using CT images. Two studies conducted on pancreatic cancer demonstrated that morphological changes in blood vessels and the length of contact between the tumor and the vessels were risk factors for vascular invasion ( 7 , 8 ). A study investigating mediastinal great vein invasion of TETs identified the irregularity of tumor margins, the interface between the tumor and great vein, and the absence of soft tissue in the interface as potential indicators of vascularly invasive TETs ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

The predictive value of a computed tomography-based radiomics model for the surgical separability of thymic epithelial tumors from the superior vena cava and the left innominate vein

Li,

Wang,

Zhang

et al. 2023

Quant Imaging Med Surg

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Background The aim of this study was to develop a radiomics machine learning model based on computed tomography (CT) that can predict whether thymic epithelial tumors (TETs) can be separated from veins during surgery and to compare the accuracy of the radiomics model to that of radiologists. Methods Patients who underwent thymectomy at our hospital from 2009 to 2017 were included in the screening process. After the selection of patients according to the inclusion and exclusion criteria, the cohort was randomly divided into training and testing groups, and CT images of these patients were collected. Subsequently, two-dimensional (2D) and three-dimensional (3D) regions of interest were labelled using ITK-SNAP 3.8.0 software, and Radiomics features were extracted using Python software (Python Software Foundation) and selected through the least absolute shrinkage and selection operator (LASSO) regression model. To construct the classifier, a support vector machine (SVM) was employed, and a nomogram was created using logistic regression to predict vascular inseparable TETs based on the radiomics score (radscore) and image features. To assess the accuracy of these models, area under receiver operating characteristic (ROC) curves of these models were calculated, and differences among the models were identified using the Delong test. Results In this retrospective study, 204 patients with TETs were included, among whom 21 were diagnosed with surgical vascularly inseparable TETs. The area under ROC curve (AUC) of the 2D model, 3D model, 2D + 3D model, and radiologist diagnoses were 0.94, 0.92, 0.95, and 0.87 in the training cohort and 0.95, 0.92, 0.98, and 0.78 in testing cohort, respectively. The Delong test revealed a significant improvement in the performance of the radiomics models compared to radiologists’ diagnoses. The logistic regression selected 3 image features, namely maximum diameter of the tumor, degree of abutment of vessel circumference >50%, and absence of the mediastinal fat layer or space between the tumor and surrounding structures. These features, along with the radscore, were included to develop a nomogram. The AUCs of this nomogram were 0.99 in both the training set and testing set, and the Delong test did not find a significant difference between ROC plots of the nomogram and radiomics models. Conclusions The proposed radiomics model could accurately predict surgical vascularly inseparable TETs preoperatively and was shown to have a higher predictive value than the radiologists.

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Preoperative CT staging of borderline pancreatic cancer patients after neoadjuvant treatment: accuracy in the prediction of vascular invasion and resectability

Cited by 14 publications

References 34 publications

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

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

Radiologic Evaluation for Resectability of Pancreatic Adenocarcinoma

The predictive value of a computed tomography-based radiomics model for the surgical separability of thymic epithelial tumors from the superior vena cava and the left innominate vein

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