Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 10/2016

01-09-2016 | Original Article

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

Authors: Bang-Bin Chen, Yu-Wen Tien, Ming-Chu Chang, Mei-Fang Cheng, Yu-Ting Chang, Chih-Horng Wu, Xin-Jia Chen, Ting-Chun Kuo, Shih-Hung Yang, I-Lun Shih, Hong-Shiee Lai, Tiffany Ting-Fang Shih

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2016

Login to get access

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.
Literature
1.
2.
Ma J, Jemal A. The rise and fall of cancer mortality in the USA: why does pancreatic cancer not follow the trend? Future Oncol. 2013;9:917–9.CrossRefPubMed
3.
Huellner MW, Appenzeller P, Kuhn FP, Husmann L, Pietsch CM, Burger IA, et al. Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: preliminary observations. Radiology. 2014;273:859–69.CrossRefPubMed
4.
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.CrossRefPubMed
5.
Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, et al. Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology. 2015;274:45–63.CrossRefPubMed
6.
7.
Penet MF, Shah T, Bharti S, Krishnamachary B, Artemov D, Mironchik Y, et al. Metabolic imaging of pancreatic ductal adenocarcinoma detects altered choline metabolism. Clin Cancer Res. 2015;21:386–95.CrossRefPubMed
8.
Ying H, Kimmelman AC, Lyssiotis CA, Hua S, Chu GC, Fletcher-Sananikone E, et al. Oncogenic Kras maintains pancreatic tumors through regulation of anabolic glucose metabolism. Cell. 2012;149:656–70.CrossRefPubMedPubMedCentral
9.
Rakheja R, Chandarana H, DeMello L, Jackson K, Geppert C, Faul D, et al. Correlation between standardized uptake value and apparent diffusion coefficient of neoplastic lesions evaluated with whole-body simultaneous hybrid PET/MRI. AJR Am J Roentgenol. 2013;201:1115–9.CrossRefPubMed
10.
Schaarschmidt BM, Buchbender C, Nensa F, Grueneisen J, Gomez B, Kohler J, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in lymph node metastases of non-small cell lung cancer (NSCLC) patients using hybrid 18F-FDG PET/MRI. PLoS One. 2015;10, e0116277.CrossRefPubMedPubMedCentral
11.
Baba S, Isoda T, Maruoka Y, Kitamura Y, Sasaki M, Yoshida T, et al. Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: comparison with apparent diffusion coefficient from diffusion-weighted MR imaging. J Nucl Med. 2014;55:736–42.CrossRefPubMed
12.
Shih IL, Yen RF, Chen CA, Chen BB, Wei SY, Chang WC, et al. Standardized uptake value and apparent diffusion coefficient of endometrial cancer evaluated with integrated whole-body PET/MR: correlation with pathological prognostic factors. J Magn Reson Imaging. 2015;42:1723–32. doi:10.​1002/​jmri.​24932.CrossRefPubMed
13.
Grueneisen J, Beiderwellen K, Heusch P, Buderath P, Aktas B, Gratz M, et al. Correlation of standardized uptake value and apparent diffusion coefficient in integrated whole-body PET/MRI of primary and recurrent cervical cancer. PLoS One. 2014;9, e96751.CrossRefPubMedPubMedCentral
14.
Yu X, Lee EY, Lai V, Chan Q. Correlation between tissue metabolism and cellularity assessed by standardized uptake value and apparent diffusion coefficient in peritoneal metastasis. J Magn Reson Imaging. 2014;40:99–105.CrossRefPubMed
15.
Tozaki M, Hoshi K. 1H MR spectroscopy of invasive ductal carcinoma: correlations with FDG PET and histologic prognostic factors. AJR Am J Roentgenol. 2010;194:1384–90.CrossRefPubMed
16.
Yamaguchi T, Lee J, Uemura H, Sasaki T, Takahashi N, Oka T, et al. Prostate cancer: a comparative study of 11C-choline PET and MR imaging combined with proton MR spectroscopy. Eur J Nucl Med Mol Imaging. 2005;32:742–8.CrossRefPubMed
17.
Ma C, Liu L, Li J, Wang L, Chen LG, Zhang Y, et al. Apparent diffusion coefficient (ADC) measurements in pancreatic adenocarcinoma: a preliminary study of the effect of region of interest on ADC values and interobserver variability. J Magn Reson Imaging. 2016;43:407–13. doi:10.​1002/​jmri.​25007.CrossRefPubMed
18.
Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50.
19.
Romesser PB, Qureshi MM, Subramaniam RM, Sakai O, Jalisi S, Truong MT. A prognostic volumetric threshold of gross tumor volume in head and neck cancer patients treated with radiotherapy. Am J Clin Oncol. 2014;37:154–61.CrossRefPubMed
20.
Chirindel A, Alluri KC, Chaudhry MA, Wahl RL, Pawlik TM, Herman JM, et al. Prognostic value of FDG PET/CT-derived parameters in pancreatic adenocarcinoma at initial PET/CT staging. AJR Am J Roentgenol. 2015;204:1093–9.CrossRefPubMed
21.
Larson SM, Erdi Y, Akhurst T, Mazumdar M, Macapinlac HA, Finn RD, et al. Tumor treatment response based on visual and quantitative changes in global tumor glycolysis using PET-FDG imaging. The visual response score and the change in total lesion glycolysis. Clin Positron Imaging. 1999;2:159–71.CrossRefPubMed
22.
Shrikhande SV, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I, et al. Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2007;14:118–27.CrossRefPubMed
23.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
24.
Muraoka N, Uematsu H, Kimura H, Imamura Y, Fujiwara Y, Murakami M, et al. Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations. J Magn Reson Imaging. 2008;27:1302–8.CrossRefPubMed
25.
Wang Y, Chen ZE, Nikolaidis P, McCarthy RJ, Merrick L, Sternick LA, et al. Diffusion-weighted magnetic resonance imaging of pancreatic adenocarcinomas: association with histopathology and tumor grade. J Magn Reson Imaging. 2011;33:136–42.CrossRefPubMed
26.
Hayano K, Miura F, Amano H, Toyota N, Wada K, Kato K, et al. Correlation of apparent diffusion coefficient measured by diffusion-weighted MRI and clinicopathologic features in pancreatic cancer patients. J Hepatobiliary Pancreat Sci. 2013;20:243–8.CrossRefPubMed
27.
Niwa T, Ueno M, Ohkawa S, Yoshida T, Doiuchi T, Ito K, et al. Advanced pancreatic cancer: the use of the apparent diffusion coefficient to predict response to chemotherapy. Br J Radiol. 2009;82:28–34.CrossRefPubMed
28.
Kurosawa J, Tawada K, Mikata R, Ishihara T, Tsuyuguchi T, Saito M, et al. Prognostic relevance of apparent diffusion coefficient obtained by diffusion-weighted MRI in pancreatic cancer. J Magn Reson Imaging. 2015;42:1532–7. doi:10.​1002/​jmri.​24939.CrossRefPubMed
29.
Lee JW, Kang CM, Choi HJ, Lee WJ, Song SY, Lee JH, et al. Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with pancreatic cancer. J Nucl Med. 2014;55:898–904.CrossRefPubMed
30.
Shi S, Ji S, Qin Y, Xu J, Zhang B, Xu W, et al. Metabolic tumor burden is associated with major oncogenomic alterations and serum tumor markers in patients with resected pancreatic cancer. Cancer Lett. 2015;360:227–33.CrossRefPubMed
31.
Xu HX, Chen T, Wang WQ, Wu CT, Liu C, Long J, et al. Metabolic tumour burden assessed by 18F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection. Eur J Nucl Med Mol Imaging. 2014;41:1093–102.CrossRefPubMed
32.
Choi HJ, Lee JW, Kang B, Song SY, Lee JD, Lee JH. Prognostic significance of volume-based FDG PET/CT parameters in patients with locally advanced pancreatic cancer treated with chemoradiation therapy. Yonsei Med J. 2014;55:1498–506.CrossRefPubMedPubMedCentral
33.
Dholakia AS, Chaudhry M, Leal JP, Chang DT, Raman SP, Hacker-Prietz A, et al. Baseline metabolic tumor volume and total lesion glycolysis are associated with survival outcomes in patients with locally advanced pancreatic cancer receiving stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2014;89:539–46.CrossRefPubMedPubMedCentral
34.
Sakane M, Tatsumi M, Kim T, Hori M, Onishi H, Nakamoto A, et al. Correlation between apparent diffusion coefficients on diffusion-weighted MRI and standardized uptake value on FDG-PET/CT in pancreatic adenocarcinoma. Acta Radiol. 2015;56:1034–41.CrossRefPubMed
35.
Soussan M, Cyrta J, Pouliquen C, Chouahnia K, Orlhac F, Martinod E, et al. Fluorine 18 fluorodeoxyglucose PET/CT volume-based indices in locally advanced non-small cell lung cancer: prediction of residual viable tumor after induction chemotherapy. Radiology. 2014;272:875–84.CrossRefPubMed
36.
Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.CrossRefPubMed
37.
Davison J, Mercier G, Russo G, Subramaniam RM. PET-based primary tumor volumetric parameters and survival of patients with non-small cell lung carcinoma. AJR Am J Roentgenol. 2013;200:635–40.CrossRefPubMed
38.
Chang KP, Tsang NM, Liao CT, Hsu CL, Chung MJ, Lo CW, et al. Prognostic significance of 18F-FDG PET parameters and plasma Epstein-Barr virus DNA load in patients with nasopharyngeal carcinoma. J Nucl Med. 2012;53:21–8.CrossRefPubMed
39.
Dibble EH, Alvarez AC, Truong MT, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med. 2012;53:709–15.CrossRefPubMed
40.
Tesiram YA, Lerner M, Stewart C, Njoku C, Brackett DJ. Utility of nuclear magnetic resonance spectroscopy for pancreatic cancer studies. Pancreas. 2012;41:474–80.CrossRefPubMed
41.
Yao X, Zeng M, Wang H, Fei S, Rao S, Ji Y. Metabolite detection of pancreatic carcinoma by in vivo proton MR spectroscopy at 3T: initial results. Radiol Med. 2012;117:780–8.CrossRefPubMed
42.
Ahn SJ, Park MS, Lee JD, Kang WJ. Correlation between 18F-fluorodeoxyglucose positron emission tomography and pathologic differentiation in pancreatic cancer. Ann Nucl Med. 2014;28:430–5.CrossRefPubMed
Metadata
Title
 PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis
Authors
Bang-Bin Chen
Yu-Wen Tien
Ming-Chu Chang
Mei-Fang Cheng
Yu-Ting Chang
Chih-Horng Wu
Xin-Jia Chen
Ting-Chun Kuo
Shih-Hung Yang
I-Lun Shih
Hong-Shiee Lai
Tiffany Ting-Fang Shih
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-016-3356-y

Other articles of this Issue 10/2016

European Journal of Nuclear Medicine and Molecular Imaging 10/2016 Go to the issue

Original Article

Dual time-point FDG PET/CT and FDG uptake and related enzymes in lymphadenopathies: preliminary results

Erratum

Erratum to: Development of a nomogram combining clinical staging with 18F-FDG PET/CT image features in non-small-cell lung cancer stage I–III

Obituary

In memoriam: Prof. Dr. Edwaldo Eduardo Camargo (1938–2016)

Original Article

PET/CT comparing 68Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma

Original Article

Human brown adipose tissue [15O]O2 PET imaging in the presence and absence of cold stimulus

Review Article

Contribution of 18F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis