Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study

Marion-Audibert, Anne-Marie; Vullierme, Marie‐Pierre; Ronot, Maxime; Mabrut, Jean‐Yves; Sauvanet, Alain; Zins, Marc; Cuilleron, Muriel; Cunha, Antonio Sa; Lévy, Philippe; Rode, Agnès

doi:10.2214/ajr.18.19640

Cited by 69 publications

(58 citation statements)

References 33 publications

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“…Thus, in a retrospective study of 54 patients with histologically documented PDA and a total of 62 liver metastases 10 mm in mean size, sensitivity for liver metastasis detection was 85% with MR imaging after gadoxetic acid injection versus only 69% with multidetector CT (P = .04), even though the MR imaging protocol did not involve diffusion imaging (57). Furthermore, a prospective multicenter unpublished study showed that, among patients whose PDA was deemed resectable based on multiphase pancreatic multidetector CT findings, 10% had one or more liver metastases detected with liver MR imaging including diffusion-weighted sequences (58). Finally, a recent study compared two patient cohorts, one assessed by only using multidetector CT (n = 102) and the other by using both multidetector CT and MR imaging (n = 65), for the pretreatment staging of potentially resectable PDA (59).…”

Section: Limitations Of Imaging Studies For Initial Stagingmentioning

confidence: 99%

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

2018

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Pancreatic ductal adenocarcinoma (PDA) remains among the most challenging malignancies to treat. At diagnosis, the tumor often already extends beyond the confines of the pancreas, spreading to an extent such that primary surgery with curative intent is very rarely feasible. Considerable momentum is now being given to a treatment strategy involving neoadjuvant chemotherapy or chemotherapy and radiation therapy in patients with nonmetastatic PDA. The main advantage of this strategy is better selection of patients likely to benefit from curative-intent surgery through the achievement of negative resection margins. Patients with rapidly progressive disease are identified and are spared ineffective surgery with its attendant morbidity. Neoadjuvant therapy can downstage tumors classified as locally advanced at initial imaging studies to resectable tumors. However, the imaging study evaluation of the response to neoadjuvant therapy is extremely complex. Thus, the diagnostic performance of imaging studies is not sufficient to ensure the accurate selection of patients in whom negative-margin resection is likely to be achieved. More specifically, standard criteria for predicting vascular invasion, based on the amount of tumor-vessel contact, are not valid after neoadjuvant therapy.

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Section: Limitations Of Imaging Studies For Initial Stagingmentioning

confidence: 99%

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

2018

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“…Not surprisingly, liver DW-MRI appeared to be a crucial tool for staging as already reported [4,22].…”

Section: Non-resection Ratementioning

confidence: 71%

“…During the last two decades, the performance of CT scan and liver diffusion weighted magnetic resonance imaging (DW-MRI) [4,5] have improved dramatically; consequently, the non-resection rate (NRR) is expected to decrease during this period because these improvements should make it possible to detect extrapancreatic lesions (especially liver metastases) of smaller sizes. However, at the same time, two crucial points might have counterbalanced the improved e ciency of preoperative imaging.…”

Section: Introductionmentioning

confidence: 99%

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

Mattevi

Garnier

Marchese

et al. 2020

Preprint

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Purpose To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). Methods From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P <.01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P <.01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (24% vs 25%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes invasion rate (0.4% vs 4.6%; P <0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9mm vs 6.4mm ( P <.01), respectively) when the resection was not done. In multivariate analysis, CA 19-9<500U/mL ( P <.01), and liver DW-MRI prescription ( P <.01) favoured the resection. Conclusions Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

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“…This question was evaluated in two recent studies because 13%‐23% of patients who undergo a surgical procedure are found to have unresectable disease because of vascular involvement, peritoneal carcinomatosis or undiagnosed liver metastases. Liver metastases were seen in both studies on MRI in 10%‐23% of the patients and were later confirmed, avoiding unnecessary laparotomy …”

Section: What's New For Staging Malignant Liver Tumours?mentioning

confidence: 83%

Imaging of liver tumours: What’s new?

Vilgrain

Raynaud

Paulatto

et al. 2020

Liver International

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Liver tumours are very common and malignant tumours represent a major cause of cancer‐related death. Imaging plays an important role at many different stages of the care pathway. This review discusses new aspects and new roles for imaging and for MRI, in particular. MRI is already the best tool for the characterization and staging of benign and malignant liver tumours and it could also become a useful screening tool, especially for hepatocellular carcinoma. Liver imaging will be increasingly quantitative in the future, integrating new approaches such as those of artificial intelligence.

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Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study

Cited by 69 publications

References 33 publications

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy

Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

Imaging of liver tumours: What’s new?

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