DOI: 10.1007/s00259-018-3960-0Pages: 1-13

Multiparametric PET/MR imaging biomarkers are associated with overall survival in patients with pancreatic cancer

1. National Taiwan University College of Medicine and Hospital, Department of Medical Imaging and Radiology

2. National Taiwan University College of Medicine and Hospital, Department of Surgery

3. National Taiwan University College of Medicine and Hospital, Department of Internal Medicine

4. National Taiwan University College of Medicine and Hospital, Department of Nuclear Medicine and Radiology

5. National Taiwan University College of Medicine and Hospital, Department of Oncology

Correspondence to:
Tiffany Ting-Fang Shih
Tel: 886-2-23123456
Email: ttfshih@ntu.edu.tw

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Abstract

Purpose

To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography (18F–FDG PET)/MRI in patients with pancreatic cancer.

Methods

This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters (peak, IAUC60, Ktrans, kep, ve), the minimum apparent diffusion coefficient (ADCmin), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models.

Results

Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P = 0.041), high peak (P = 0.006), high ADCmin (P = 0.002) and low TLG (P = 0.01) had better OS. Moreover, high TLG/peak ratio was associated with poor OS (P = 0.016). Multivariate analysis indicated that ADCmin (P = 0.011) and TLG/peak ratio (P = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery (P = 0.013).

Conclusion

The flow-metabolism mismatch reflected by the TLG/peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.

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  • Accepted: Jan 22, 2018
  • Online: Feb 23, 2018

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