The utility of Multi-Detector Computed Tomography criteria after neoadjuvant therapy in Borderline Resectable Pancreatic cancer: Prospective, bi-institutional study

Ahmed, Shaimaa; Atta, Haisam; Hassan, Ramy A.

doi:10.1016/j.ejrad.2021.109685

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…MDCT provides good spatial resolution with wide anatomic coverage, which allows comprehensive evaluation of local and distant disease in a single session[ 8 ]. Notably, MDCT is proved to be a useful tool in assessment of vascular involvement, which is one of the deciding factors of tumor resectability[ 9 , 10 ]. The American Joint Committee on Cancer (AJCC) TNM staging criteria has been developed to characterize local and systemic spread PDAC.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma

Ren,

Qian,

Cao

et al. 2024

World J Gastrointest Oncol

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BACKGROUND One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma (PDAC) is that most patients are usually diagnosed at late stages. There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages. AIM To evaluate the potential value of radiomics analysis in the differentiation of early-stage PDAC from late-stage PDAC. METHODS A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography (CT) within 30 d prior to surgery were included in the study. Tumor staging was performed in accordance with the 8th edition of the American Joint Committee on Cancer staging system. Radiomics features were extracted from the region of interest (ROI) for each patient using Analysis Kit software. The most important and predictive radiomics features were selected using Mann-Whitney U test, univariate logistic regression analysis, and minimum redundancy maximum relevance (MRMR) method. Random forest (RF) method was used to construct the radiomics model, and 10-times leave group out cross-validation (LGOCV) method was used to validate the robustness and reproducibility of the model. RESULTS A total of 792 radiomics features (396 from late arterial phase and 396 from portal venous phase) were extracted from the ROI for each patient using Analysis Kit software. Nine most important and predictive features were selected using Mann-Whitney U test, univariate logistic regression analysis, and MRMR method. RF method was used to construct the radiomics model with the nine most predictive radiomics features, which showed a high discriminative ability with 97.7% accuracy, 97.6% sensitivity, 97.8% specificity, 98.4% positive predictive value, and 96.8% negative predictive value. The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models. CONCLUSION The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.

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Section: Introductionmentioning

confidence: 99%

Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma

Ren,

Qian,

Cao

et al. 2024

World J Gastrointest Oncol

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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%

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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“…Therefore, the characteristics of PDAC make its efficacy less suitable for evaluation via CT. 19,20 With the development of imaging techniques, multiple methods have been used to evaluate the efficacy of NAT for PDAC. 8,[21][22][23] Magnetic resonance imaging (MRI) can better visualize pancreatic and tumor tissue components, particularly as a reflection of the degree of fibrosis, microvessel density, and tissue hypoxia. Alongside its ability to detect changes in tumor tissue components earlier than CT, it may be more valuable in evaluating NAT for PDAC.…”

mentioning

confidence: 99%

“…With the development of imaging techniques, multiple methods have been used to evaluate the efficacy of NAT for PDAC 8,21–23 . Magnetic resonance imaging (MRI) can better visualize pancreatic and tumor tissue components, particularly as a reflection of the degree of fibrosis, microvessel density, and tissue hypoxia.…”

mentioning

confidence: 99%

Application of Magnetic Resonance Imaging in Neoadjuvant Treatment of Pancreatic Ductal Adenocarcinoma

Zeng

Wang

et al. 2022

Magnetic Resonance Imaging

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Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignant tumors of the human digestive system. Due to its insidious onset, many patients have already lost the opportunity for radical resection upon tumor diagnosis. In recent years, neoadjuvant treatment for patients with borderline resectable PDAC has been recommended by multiple guidelines to increase the resection rate of radical surgery and improve the postoperative survival. However, further developments are required to accurately assess the tumor response to neoadjuvant therapy and to select the population suitable for such treatment. Reductions in drug toxicity and the number of neoadjuvant cycles are also critical. At present, the clinical evaluation of neoadjuvant treatment is mainly based on several serological and imaging indicators; however, the unique characteristics of PDAC and the insufficient sensitivity and specificity of the markers render this system ineffective. The imaging evaluation system, magnetic resonance imaging (MRI), has its own unique imaging advantages compared with computed tomography (CT) and other imaging examinations. One key advantage is the ability to reflect the changes more rapidly in tumor tissue components, such as the degree of fibrosis, microvessel density, and tissue hypoxia. It can also perform multiparameter quantitative analysis of tumor tissue and changes, attributing to its increasingly important role in imaging evaluation, and potentially the evaluation of neoadjuvant treatment of pancreatic cancer, as several current articles have studied. At the same time, owing to the complexity of MRI and some of its limitations, its wider application is limited. Compared with CT imaging, few relevant studies have been conducted. In this review article, we will investigate and summarize the advantages, limitations, and future development of MRI in the evaluation of neoadjuvant treatment of PDAC. Evidence Level 3 Technical Efficacy Stage 2

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The utility of Multi-Detector Computed Tomography criteria after neoadjuvant therapy in Borderline Resectable Pancreatic cancer: Prospective, bi-institutional study

Cited by 6 publications

References 30 publications

Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma

Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma

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

Application of Magnetic Resonance Imaging in Neoadjuvant Treatment of Pancreatic Ductal Adenocarcinoma

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