Cancer Res Treat.  2019 Jan;51(1):24-33. 10.4143/crt.2017.404.

Incremental Role of Pancreatic Magnetic Resonance Imaging after Staging Computed Tomography to Evaluate Patients with Pancreatic Ductal Adenocarcinoma

• Kim HJ
• Park MS
• Lee JY
• Han K
• Chung YE
• Choi JY
• Kim MJ
• Kang CM

• KMID: 2437595
• DOI: http://doi.org/10.4143/crt.2017.404

Abstract

PURPOSE
The purpose of this study was to investigate the impact of contrast enhanced pancreatic magnetic resonance imaging (MRI) in resectability and prognosis evaluation after staging computed tomography (CT) in patients with pancreatic ductal adenocarcinoma (PDA).
MATERIALS AND METHODS
From January 2005 to December 2012, 298 patients were diagnosed to have potentially resectable stage PDA on CT. Patients were divided into CT+MR (patients underwent both CT and MRI; n=216) and CT only groups (n=82). Changes in resectability staging in the CT+MR group were evaluated. The overall survival was compared between the two groups. The recurrence-free survival and median time to liver metastasis after curative surgery were compared between the two groups.
RESULTS
Staging was changed from resectable on CT to unresectable state on MRI in 14.4% of (31 of 216 patients) patients of the CT+MR group. The overall survival and recurrence-free survival rates were not significantly different between the two groups (p=0.162 and p=0.721, respectively). The median time to liver metastases after curative surgery in the CT+MR group (9.9 months) was significantly longer than that in the CT group (4.2 months) (p=0.011).
CONCLUSION
Additional MRI resulted in changes of resectability and treatment modifications in a significant proportion of patients who have potentially resectable state at CT and in prolonged time to liver metastases in patients after curative surgery. Additional MRI to standard staging CT can be recommended for surgical candidates of PDA.

Keyword

Pancreas ductal adenocarcinoma; Computed tomography; Magnetic resonance imaging; Resectability

MeSH Terms

Adenocarcinoma*
Humans
Liver
Magnetic Resonance Imaging*
Neoplasm Metastasis
Pancreatic Ducts*
Prognosis
Survival Rate

Figure

• 

  Fig. 1. Flow diagram of study population. PDA, pancreas ductal adenocarcinoma; CT, computed tomography; NCCN, National Comprehensive Cancer Network; MRI, magnetic resonance imaging.

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  Fig. 2. Computed tomography (CT) and magnetic resonance (MR) images obtained in a 65-year-old man with pancreas ductal adenocarcinoma. (A, B) Portal phase CT image demonstrates no focal liver lesion (A). This patient was classified into surgically resectable state at CT (pancreas cancer not seen at this image). However, additional gadoxetic acid-enhanced MR image shows multiple subcentimeter low signal intensity nodules indicating hepatic metastases at hepatobiliary phase (arrowheads) (B). Finally, this patient was reclassified into unresectable state after MR imaging.

• 

  Fig. 3. Overall survival of patients belonged to the potentially resectable (PR) CT+MR group (patients underwent both computed tomography and magnetic resonance imaging) and the unresectable (UR) CT+MR group.

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  Fig. 4. Time to liver metastases in the computed tomography (CT) only and the CT+MR (patients underwent both CT and magnetic resonance imaging) groups of patients who received curative surgical treatment.

Reference

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