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Abstract
BackgroundThe accurate determination of resectability in patients with pancreatic cancer is a main goal of preoperative imaging after diagnosis. With advances in surgical techniques, the definition of resectability is in evolution, and it is crucial for radiologists to have an understanding of findings that are relevant to the determination of resectability. The parallel advancements in imaging technology are aiming to improve the ability of imaging modalities to predict resectability. Fifty patients with pancreatic ductal adenocarcinoma (PDAC) were analyzed for capability of apparent diffusion coefficient (ADC) values to predict possible tumor resectability. The patients were classified into resectable and unresectable groups based on magnetic resonance (MR) imaging criteria. Logistic regression analysis was used. Receiver operator characteristic (ROC) curve was reconstructed.ResultsOut of different prognostic variables, tumor size was the only significant predictor of tumor resectability. ROC curve analysis showed that ADC value is not a discriminator of tumor resectability (area under the curve (AUC) = 0.5, P value = 0.452).ConclusionsIn patients with pancreatic adenocarcinoma, ADC values might be unreliable for prediction of tumor resectability in clinical practice. Low ADC value in such tumors is more attributed to fibrotic nature rather than grade of the tumor.
Highlights
The accurate determination of resectability in patients with pancreatic cancer is a main goal of preoperative imaging after diagnosis
Due to the lack of early specific symptoms and tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage, many patients with pancreatic cancer already have advanced disease at the time of diagnosis resulting in a high mortality rate [3]
The following pulse sequences were obtained for all patients: T1WI: axial plane, Time of repetition (TR)/Time to echo (TE) 992/10 ms, slice thickness 7 mm with inter-slice gap of 1 mm and 248 × 384 matrix; T2WI: axial or coronal plane, TR/TE 1448/100 ms, slice thickness 7 mm with inter-slice gap of 1 mm and 128 × 384 matrix; T2 Selective partial inversion recovery (SPIR): axial or coronal plane, TR/TE460/80, slice thickness 5 mm with inter-slice gap of 1 mm and 128 × 288 matrix; Diffusion-weighted image (DWI): free-breathing single-shot spin-echo-based diffusionweighted images in axial plane, TR/TE 2500/123 ms, slice thickness 7 mm with inter-slice gap of 1 mm and 182 × 192 matrix: at b values (0, 500, 1000) followed by computergenerated apparent diffusion coefficient (ADC) mapping of the pancreas
Summary
The accurate determination of resectability in patients with pancreatic cancer is a main goal of preoperative imaging after diagnosis. Fifty patients with pancreatic ductal adenocarcinoma (PDAC) were analyzed for capability of apparent diffusion coefficient (ADC) values to predict possible tumor resectability. Despite recent advances in imaging and management strategies, pancreatic adenocarcinoma continues to be one of the most common causes of cancer-related mortality worldwide [1, 2]. Due to the lack of early specific symptoms and tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage, many patients with pancreatic cancer already have advanced disease at the time of diagnosis resulting in a high mortality rate [3]. Surgical resection is the only potentially curative technique for managing pancreatic cancer.
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