Abstract
ObjectivesTo evaluate gadoxetic acid-enhanced liver MRI (EOB-MRI) versus contrast-enhanced computed tomography (CECT) for preoperative detection of liver metastasis (LM) and reduction of open-close laparotomies for pancreatic ductal adenocarcinoma (PDAC).MethodsSixty-six patients with PDAC had undergone preoperative EOB-MRI and CECT. LM detection by EOB-MRI and CECT and their impact on surgical planning, open-close laparotomies were compared by clinical and radiology reports and retrospective analysis of imaging by two blinded independent readers. Histopathology or imaging follow-up was the reference standard. Statistical analysis was performed at patient and lesion levels with two-sided McNemar tests.ResultsEOB-MRI showed higher sensitivity versus CECT (71.7% [62.1-80.0] vs. 34% [25.0-43.8]; p = 0.009), comparable specificity (98.6%, [96.9-99.5] vs. 100%, [99.1-100], and higher AUROC (85.1%, [80.4-89.9] vs. 66.9%, [60.9-73.1]) for LM detection. An incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6% in futile open-close laparotomies due to LM detected on EOB-MRI only.ConclusionsPreoperative EOB-MRI has superior diagnostic performance in detecting LM from PDAC. This better informs surgical eligibility with potential reduction of futile open-close laparotomies from attempted curative intent pancreatic cancer surgery.
Highlights
Inclusion of gadoxetic acid-enhanced liver MRI can reduce the incidence of failed curative intent pancreatic cancer surgeries
Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis with an overall 5-year survival rate of Jhaveri et al Cancer Imaging (2021) 21:45 approximately 8% [1]
Our study showed that Gadoxetic acid-enhanced Magnetic Resonance Imaging (EOB-MRI) had very high Positive predictive value (PPV) and Negative predictive values (NPV) for diagnosis of liver metastasis (LM) from pancreatic ductal adenocarcinoma (PDAC)
Summary
Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis with an overall 5-year survival rate of Jhaveri et al Cancer Imaging (2021) 21:45 approximately 8% (range 3-32% depending on the stage) [1]. Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC) [2] and unlike colorectal cancer, preoperative detection of liver metastasis (LM) precludes curative surgery. Contrast-enhanced computed tomography (CECT) is the most commonly used imaging modality for staging pancreatic cancer with its ability to detect local extension and distant metastasis [5, 6]. Unexpected adverse findings, in particular LM, have been reported intraoperatively in 8-26% with potentially resectable pancreatic cancer on CECT [7,8,9], resulting in aborted surgeries [10]. It is of great relevance to detect LM on preoperative imaging to avoid futile (openclose) laparotomies and resultant associated postoperative morbidity/mortality and added hospitalization costs [11]
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