Is magnetic resonance diffusion-weighted imaging superior in the diagnosis of pancreatic adenocarcinoma and does it have a prognostic value?

Abstract

AimTo assess how beneficial is adding Magnetic Resonance Diffusion-Weighted Imaging (DWI) to conventional MRI in the identification, characterization, and prognostic assessment of pancreatic duct adenocarcinoma (PDAC). Materials and MethodsWe included 34 consecutive patients with pancreatic malignancies who had conventional MRI and DWI performed and were followed up after treatment. ResultsThe apparent diffusion coefficient (ADC) values of malignant pancreatic mass lesions ranged from 0.9 to 1.5 × 10−3s/mm2 at b-1000, with a mean of 1.2 ± 0.18093. For the surrounding parenchyma, the ADC values were from 1.8 to 2.9 × 10−3s/mm2 at b-1000, with a mean of 2.3 ± 0.35506. These values showed a statistically significant difference (P < 0.001). The ADC cut-off value for the differentiation of malignant pancreatic masses from surrounding normal tissue, in this group of patients was, 1.7 × 10−3 s/mm2 with a sensitivity of 97% and a specificity 93%.In PDAC, a statistically significant difference in survival was found according to ADC (p = 0.026), as patients with high ADC had better survival. ConclusionDWI added to conventional imaging is a superior modality that aids in differentiating PDAC from the unaffected parenchyma, but not from other malignancies, with a recommended b-value 1000 s/mm2. Higher ADC may also be associated with better survival for PDAC patients.