Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma

Remy Klaassen; Oliver J Gurney-Champion; Johanna W Wilmink; Marc G Besselink; Marc R W Engelbrecht; Jaap Stoker; Aart J Nederveen; Hanneke W M van Laarhoven

doi:10.1016/j.mri.2018.02.005

Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma

Magn Reson Imaging. 2018 Jul:50:1-9. doi: 10.1016/j.mri.2018.02.005. Epub 2018 Feb 21.

Authors

Remy Klaassen¹, Oliver J Gurney-Champion², Johanna W Wilmink³, Marc G Besselink⁴, Marc R W Engelbrecht⁵, Jaap Stoker⁵, Aart J Nederveen⁵, Hanneke W M van Laarhoven³

Affiliations

¹ Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Cancer Center Amsterdam, LEXOR (Laboratory for Experimental Oncology and Radiobiology), Academic Medical Center, Amsterdam, The Netherlands. Electronic address: r.klaassen@amc.uva.nl.
² Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands.
³ Cancer Center Amsterdam, Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
⁴ Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
⁵ Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 29476781
DOI: 10.1016/j.mri.2018.02.005

Abstract

Background: In current oncological practice of pancreatic ductal adenocarcinoma (PDAC), there is a great demand for response predictors and markers for early treatment evaluation. In this study, we investigated the repeatability and the interaction of dynamic contrast enhanced (DCE) and T2* MRI in patients with advanced PDAC to enable for such evaluation using these techniques.

Materials & methods: 15 PDAC patients underwent two DCE, T2* and anatomical 3 T MRI sessions before start of treatment. Parametric maps were calculated for the transfer constant (K^trans), rate constant (k_ep), extracellular extravascular space (v_e) and perfusion fraction (v_p). Quantitative R2* (1/T2*) maps were obtained from the multi-echo T2* images. Differences between normal and cancerous pancreas were determined using a Wilcoxon matched pairs test. Repeatability was obtained using Bland-Altman analysis and relations between DCE and T2*/R2* were observed by Spearman correlation and voxel-wise binned plots of tumor voxels.

Results: PDAC K^trans (p = 0.007), k_ep (p < 0.001), v_p (p = 0.035) were lower and v_e (p < 0.001) was higher compared to normal pancreas. The coefficient of variation between sessions was 21.8% for K^trans, 9.9% for k_ep, 19.3% for v_e, 18.2% for v_p and 18.7% for R2*. Variation between patients ranged from 20.2% for k_ep to 43.6% for K^trans. In the tumor both K^trans (r = 0.56, p = 0.030) and v_e (r = 0.54, p = 0.037) showed a positive correlation with T2*. Voxel wise analysis showed a steep increase in R2* for tumor voxels with lower K^trans and v_e.

Conclusion: We showed good repeatability of DCE and T2* related MRI parameters in advanced PDAC patients. Furthermore, we have illustrated the relation of DCE K^trans and v_e with tissue T2* and R2* indicating substantial value of these parameters for detecting tumor hypoxia in future studies. The results from our study pave the way for further response evaluation studies and patient selection based on DCE and T2* parameters.

Keywords: Magnetic resonance imaging; Pancreatic neoplasms; Perfusion imaging; Reproducibility of results; Tumor hypoxia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carcinoma, Pancreatic Ductal / diagnostic imaging*
Contrast Media*
Female
Humans
Image Enhancement / methods*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Pancreas / diagnostic imaging
Pancreatic Neoplasms / diagnostic imaging*
Reproducibility of Results

Substances

Contrast Media