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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 1  |  Page : 155-158

Value of magnetic resonance images in preoperative staging and resectability assessment of pancreatic cancer


Department of Radiology, Huaihe Hospital Henan University, Kaifeng, Henan Province, PR China

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Xiang He
Department of Radiology, Huaihe Hospital Henan University, Kaifeng 475000, Henan Province
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_590_17

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 > Abstract 

Objective: The objective of this study is to evaluate the clinical value of magnetic resonance images (MRI) in preoperative staging and resectability evaluation of pancreatic cancer.
Materials and Methods: Thirty-one pancreatic cancer patients who received operation from January 2012 to May 2017 were included in this study. The upper abdominal MRI of 31 cases were analyzed retrospectively. The results of operation and pathology were compared to evaluate the correlation between MRI staging and postoperative pathological staging of pancreatic cancer.
Results: According to pathological staging, there were 12 cases of Stage I, 13 cases of Stage II, 4 cases of Stage III, and 2 case of Stage IV. However, for preoperative MRI stage, there were 13 cases of Stage I, 14 cases of Stage II, 4 cases of Stage III. In addition, there was no significant difference in the distribution frequency of pathological staging and MRI staging (P > 0.05). This finding indicated that the results of MRI staging were consistent with that of postoperative pathological staging. The pathology I/II or III/IV stage of pancreatic cancer patients could be predicted with preoperative abdominal MRI detection, with the sensitivity of 1.00 and the specificity of 0.67.
Conclusion: MRI was clinically significant in preoperative staging and resectability assessment of pancreatic carcinoma.

Keywords: Diagnosis, magnetic resonance images, pancreatic cancer, staging


How to cite this article:
Yang S, Liu J, Jin H, He X, Nie P, Wang C. Value of magnetic resonance images in preoperative staging and resectability assessment of pancreatic cancer. J Can Res Ther 2018;14:155-8

How to cite this URL:
Yang S, Liu J, Jin H, He X, Nie P, Wang C. Value of magnetic resonance images in preoperative staging and resectability assessment of pancreatic cancer. J Can Res Ther [serial online] 2018 [cited 2019 Dec 12];14:155-8. Available from: http://www.cancerjournal.net/text.asp?2018/14/1/155/226744


 > Introduction Top


Pancreatic cancer has been a common type of solid malignancy with generally poor prognosis and the 5-year survival rate was <5%.[1],[2] For early-stage pancreatic tumor (diameter of <1 cm), the 5-year survival rate could exceed 90% after radical resection combined with comprehensive postoperative treatment.[3] Therefore, the keys to improve the survival rate of patients have been the timely detection of lesion, as well as a clear understanding of the nature of the lesion and the relationship between the lesion with surrounding tissues and adjacent blood vessels, with rational and comprehensive examination methods.[4],[5],[6] However, surgery was very difficult to be performed because of the special anatomical location of pancreas, which were surrounded by important organs and other structures, including duodenum, liver, and gallbladder. Preoperative evaluation and staging have been very critical to determine the extent of tumor invasion in the surrounding organs. In addition, it would be helpful in the formulation of a surgical plan and evaluation of tumor resectability.


 > Materials and Methods Top


Patients

A total of 31 patients with pancreatic cancer who received surgery in our hospital from January 2012 to May 2017 were enrolled as research objects. The magnetic resonance images (MRI) of the upper abdomen of the patients were analyzed retrospectively and contrastively based on the surgical and pathological results. The median age of all 31 patients was 61 years old. There were 21 males and 10 females. The tumor was located in pancreatic head in 14 cases, pancreatic neck in 6 cases, pancreatic body, and tail in 11 cases [Table 1].
Table 1: The general features of the include 31 cases

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Examination methods

The MRI images were obtained with PHILIPS1.5T MR scanner with eight-channel abdominal staged array surface coil. All the patients were scanned conventionally with T2-weighted imaging (T2WI), T1 weighted imaging (T1WI), diffusion-weighted imaging (DWI), and 3D fast time of flight (TOF) spoiled gradient-recalled (SPGR). The parameters were as follows: T2WI respiratory-triggered fat suppression fast spin echo (repetition time [TR] of 6000 ms, echo time [TE] of 105 ms, layer thickness of 6 mm, and interlayer spacing of 1.5 mm); T1WI (TR of 185 ms, TE of 4.2 ms, layer thickness of 6 mm, and interlayer spacing of 1.5 mm); DWI single-shot spin-echo-echo planar imaging (TR of 1500 ms, TE of 63.2 ms, layer thickness of 6 mm, and interlayer spacing of 1.5 mm); b value of 800 s/mm 2; and 3-D fast TOF SPGR (TR of 4.2 ms, TE of 1.5 ms, flip angle = 12, number of excitations = 0.75, matrix 288 × 160, and reconstruction layer thickness of 4.4 mm). The scan time involved an injection of contrast agent, which was 10 s later. Each period of scan lasted for 17 s with an interval of 3–5 s for ventilation. The results indicated about 59–61 s for the three periods. The scan would be repeated if necessary. The scope of scan included the flat surface of the diaphragmatic dome to both lower renal poles subjected with a contrast agent dosage of 0.2 mmol/kg and an injection speed of 2.5–3 mL/s. Subsequently, the tube was washed with normal saline after the injection.

Image processing

Image processing and observation were conducted by two senior doctors in MR AW4.2 workstation and PHILPS Mx8000 workstation. When the results were inconsistent, an agreement would be reached through a consultation. They focused on the analysis of the relationship between lesions and surrounding tissues. The degree of the invasion of the lesions to the peripancreatic blood vessels was scored: 5 points, peripancreatic blood vessels were apparently invaded and completely wrapped; 4 points, peripancreatic blood vessels were clearly invaded with the contact area ≥1/2 of the perimeter of the invaded blood vessels; 3 points, peripancreatic blood vessels were invaded with the wrapped area <1/2 of the perimeter of the invaded blood vessels; 2 points, peripancreatic blood vessels may be invaded; and 1 point, peripancreatic blood vessels were not invaded.

Diagnostic standard

According to the pancreatic cancer staging (6th edition) standard by the Union Internationale Contre le Cancer in 2002, pancreatic cancer was categorized into different stages. Stage IA involved a tumor that was confined to the pancreas with a diameter of ≤2 cm without lymph nodes and distant metastasis. Stage IB involved a tumor that was confined to the pancreas with a diameter of >2 cm without lymph nodes and distant metastasis. Stage IIA indicated a tumor that invaded the surrounding tissues of the pancreas while without involving the celiac trunk or superior mesenteric artery, lymph nodes, or distant metastasis. Stage IIB was characterized by a tumor that was confined to pancreas with a diameter of ≤2 cm with local lymph node metastasis but without distant metastasis. The tumor was also confined to the pancreas with a diameter of >2 cm and local lymph node metastasis but without distant metastasis, with the tumor invasion of tissues surrounding the pancreas while without involving the celiac trunk or superior mesenteric artery, with local lymph node metastasis but without distant metastasis. Stage III involved a tumor that invaded the celiac trunk or superior mesenteric artery (the primary lesion could not be removed) without distant metastasis and with or without lymph node metastasis. Stage IV was shown by distant metastasis, regardless of the tumor size, surrounding invasion, and lymph node metastasis. The gold standards were the intraoperative observation and postoperative pathological results.


 > Results Top


Magnetic resonance images staging of pancreatic cancer patients

Pancreatic cancer preoperative MRI staging was mainly based on the size of the lesion, whether the adjacent blood vessels were invaded or not; the extent of invasion, whether the adjacent tissue structures were invaded or not; and the extent of invasion, with or without lymph node metastasis and distant metastasis [Figure 1].
Figure 1: Preoperative magnetic resonance imaging of pancreatic cancer. (a-c) Cancer of the body and tail of the pancreas; (d-f) cancer of the head of pancreas

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The corresponding relationship between magnetic resonance images staging and pathological staging

According to pathological staging, there were 12 cases of Stage I, 13 cases of Stage II, 4 cases of Stage III, and 2 cases of Stage IV. However, for preoperative MRI stage, there were 13 cases of Stage I, 14 cases of Stage II, and 4 cases of Stage III. In addition, there was no significant statistic difference in the distribution frequency of MRI staging and pathological staging (P > 0.05) [Table 2]. This finding indicated that the results of MRI staging were consistent with that of postoperative pathological staging.
Table 2: The corresponding relationship between magnetic resonance images staging and pathological staging, n (%)

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Accuracy of preoperative staging of magnetic resonance images

The pathology I/II or III/IV stage of pancreatic cancer patients could be predicted with preoperative abdominal MRI detection, with a sensitivity of 1.00 and a specificity of 0.67 [Table 3].
Table 3: Accuracy of preoperative staging of magnetic resonance images

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 > Discussion Top


Pancreatic cancer was a malignant tumor of the digestive tract with a high degree of malignancy, leading to difficulties in diagnosis and treatment.[7],[8] About 90% of the pancreatic cancer cases were ductal adenocarcinoma derived from the epithelium of glandular ducts.[9],[10] The morbidity and mortality of pancreatic cancer cases in recent years have shown a significant tendency of increase. No definite symptoms and signs were observed in the early stage of pancreatic cancer. However, jaundice and other clinical manifestations generally appeared in the late stage. Therefore, the diagnosis of pancreatic cancer in early stage was difficult and the diagnosis rate was not high. Moreover, it was very difficult to perform the surgery because of the special anatomical location of pancreas, leading to a high risk of intraoperative and postoperative death. Therefore, accurate preoperative evaluation and staging have been very important for determining the extent of tumor invasion to the surrounding organs, which may contribute to the formulation of surgical programs and the evaluation of tumor respectability.[11]

Imaging examination played a very important role in determining the treatment programs of pancreatic cancer and selecting a reasonable examination, which were common issues in clinical work. The generally applied imaging techniques for the preoperative determination for pancreatic cancer staging were ultrasound, computer tomography, and MRI. However, the roles of various methods in staging of pancreatic cancer were controversial in the results of the previous studies.[12],[13] In recent years, the findings of lesions by MR, accurate staging, and the evaluation of surgical resectability have been greatly improved due to the continuous development of MR dynamic strengthening and related imaging technologies. The staging diagnosis rate of tumors could be significantly improved through observing the changes in vascular morphology and the adjacent structure of the lesions. Some scholars have reported that the cancer tissues in patients with pancreatic cancer were uniformly hyperintense in DWI with clear boundaries.[14] MRI could also dynamically reflect the movement of water molecules within the lesion, chemical shifts, and other conditions, which was able to effectively combine functions with morphology.[15] MRI performed with high accuracy in the preoperative staging of pancreatic cancer because it could appropriately combine functions and morphology. In this study, we found that, in the 31 cases of pancreatic cancer patients, there were 12 cases in Stage I, 13 cases in stage II, 4 cases in Stage III, and 2 cases in Stage IV according to pathological staging system. However, for preoperative MRI staging, there were 13 cases in Stage I, 14 cases in Stage II, and 4 cases in Stage III. In addition, no significant difference was observed in the distribution frequency of MRI staging and pathological staging (P > 0.05). This finding suggested that the results of MRI staging were consistent with that of postoperative pathological staging. At the same time, studies have found that the pathology Stage I/II or III/IV of pancreatic cancer patients could be predicted with preoperative abdominal MRI detection, with a sensitivity of 1.00 and a specificity of 0.67. This study included only a few cases (31 patients) and the statistical performance was low. Therefore, the stability of the research conclusion has been poor. Thus, it would be necessary to conduct a large-scale and multicentered prospective clinical diagnostic study to further evaluate the clinical predictive value of MR on preoperative staging and resectability evaluation of pancreatic cancer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

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Soriano A, Castells A, Ayuso C, Ayuso JR, de Caralt MT, Ginès MA, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: Prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 2004;99:492-501.  Back to cited text no. 12
    
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Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol 2010;16:818-31.  Back to cited text no. 13
    
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Chen FM, Ni JM, Zhang ZY, Zhang L, Li B, Jiang CJ, et al. Presurgical evaluation of pancreatic cancer: A comprehensive imaging comparison of CT versus MRI. AJR Am J Roentgenol 2016;206:526-35.  Back to cited text no. 14
    
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Fattahi R, Balci NC, Perman WH, Hsueh EC, Alkaade S, Havlioglu N, et al. Pancreatic diffusion-weighted imaging (DWI): Comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 2009;29:350-6.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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