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 PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To correlate the clinical stage and prognosis of pancreatic or periampullary cancer with the imaging biomarkers on diffusion-weighted imaging, magnetic resonance spectroscopy and glucose metabolic activity derived from integrated PET/MRI.

Methods

This prospective study was approved by the institutional review board and informed consent was obtained. The study group comprised 60 consecutive patients with pancreatic or periampullary cancer who underwent PET/MRI before treatment. The imaging biomarkers were the minimal apparent diffusion coefficient (ADCmin), choline levels, standardized uptake values, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) of the tumours. The relationships between these biomarkers and clinical TNM stage were evaluated using the Pearson test and the Mann-Whitney U test. The area under the receiver operating characteristic curve (AUROC) was used to evaluate accuracy. The correlation between the imaging biomarker and progression-free survival (PFS) was investigated using the Cox proportional hazards model.

Results

ADCmin was significantly lower in N1 and TNM stage 3+ tumours. Choline levels significantly higher in T4 tumours. TLG was significantly higher in T4, N1 and TNM stage 3+ tumours. MTV was significantly higher in T4, N1, M1, and TNM stage 3+ tumours (all P < 0.05). The MTV/ADCmin ratio exhibited the highest AUROC for predicting T4, N1, M1, and advanced TNM stages tumours, and was an independent predictor of PFS (P = 0.018) after adjustment for age, sex, tumour size and stage.

Conclusion

The imaging biomarkers from integrated PET/MRI may predict clinical stage and PFS in patients with pancreatic or periampullary cancer.

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Authors and Affiliations

  1. Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan

    Bang-Bin Chen, Chih-Horng Wu, Xin-Jia Chen, I-Lun Shih & Tiffany Ting-Fang Shih

  2. Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Yu-Wen Tien, Ting-Chun Kuo & Hong-Shiee Lai

  3. Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Ming-Chu Chang & Yu-Ting Chang

  4. Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Mei-Fang Cheng

  5. Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Shih-Hung Yang

  6. Department of Medical Imaging, Taipei City Hospital, Taipei, Taiwan

    Tiffany Ting-Fang Shih

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  1. Bang-Bin Chen
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Correspondence to Tiffany Ting-Fang Shih.

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Funding

The study was funded by National Taiwan University Hospital, Taipei, Taiwan; Contract grant number: A1 project no. NTUH103-A124.

Conflicts of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Chen, BB., Tien, YW., Chang, MC. et al.  PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis. Eur J Nucl Med Mol Imaging 43, 1753–1764 (2016). https://doi.org/10.1007/s00259-016-3356-y

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