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Advances in Pancreatic Cancer Imaging

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 28628

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Prof. Dr. Masakatsu Tsurusaki

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Department of Radiology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka 589-8511, Japan
Interests: hepatobiliary imaging; MR; CT; PET; liver cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pancreatic cancer is the fourth most common cause of cancer-related deaths in developed countries. To improve outcomes, there is a critical need for improved tools for detection, accurate staging, and resectability assessment. This could improve patient stratification for the most optimal primary treatment modality. Current clinical imaging protocols of pancreatic cancer include transabdominal ultrasound, computed tomography (CT) and/or magnetic resonance (MR) imaging for disease staging and prediction of resectability. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors. On the other hands, MR imaging plays an important role in the assessment of pancreatic cancer. Its superior soft tissue contrast is useful in the detection of small, non-contour-deforming tumors and for characterizing indeterminate pancreatic findings at computed tomography. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. Endoscopic ultrasound (EUS) can complement these imaging methods with valuable staging information as well as the opportunity of tissue diagnosis by fine-needle aspiration. Molecular functional imaging has the potential to play an important role in pancreatic cancer management.

This Special Issue of Cancers will cover state-of-the-art and future developments in clinical imaging of pancreatic cancer. We are inviting original research articles, reviews, and perspectives, to address some of these challenges for imaging of pancreatic cancer. We hope to discuss their current application to the management of patients with pancreatic cancer, and anticipate future developments within this field.

Dr. Masakatsu Tsurusaki
Guest Editor

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Keywords

hepatobiliary cancer
imaging
early diagnosis
CT/ MRI
preoperative imaging
tumor grading/heterogeneity
tumor progression
post-therapeutic changes
treatment response

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Published Papers (9 papers)

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Research

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13 pages, 2118 KiB

Open AccessArticle

High-Resolution, High b-Value Computed Diffusion-Weighted Imaging Improves Detection of Pancreatic Ductal Adenocarcinoma

by Felix N. Harder, Eva Jung, Sean McTavish, Anh Tu Van, Kilian Weiss, Sebastian Ziegelmayer, Joshua Gawlitza, Philip Gouder, Omar Kamal, Marcus R. Makowski, Fabian K. Lohöfer, Dimitrios C. Karampinos and Rickmer F. Braren

Cancers 2022, 14(3), 470; https://doi.org/10.3390/cancers14030470 - 18 Jan 2022

Cited by 6 | Viewed by 1946

Abstract

Background: Our purpose was to investigate the potential of high-resolution, high b-value computed DWI (cDWI) in pancreatic ductal adenocarcinoma (PDAC) detection. Materials and Methods: We retrospectively enrolled 44 patients with confirmed PDAC. Respiratory-triggered, diffusion-weighted, single-shot echo-planar imaging (ss-EPI) with both conventional (i.e., full field-of-view, 3 × 3 × 4 mm voxel size, b = 0, 50, 300, 600 s/mm²) and high-resolution (i.e., reduced field-of-view, 2.5 × 2.5 × 3 mm voxel size, b = 0, 50, 300, 600, 1000 s/mm²) imaging was performed for suspected PDAC. cDWI datasets at b = 1000 s/mm² were generated for the conventional and high-resolution datasets. Three radiologists were asked to subjectively rate (on a Likert scale of 1–4) the following metrics: image quality, lesion detection and delineation, and lesion-to-pancreas intensity relation. Furthermore, the following quantitative image parameters were assessed: apparent signal-to-noise ratio (aSNR), contrast-to-noise ratio (aCNR), and lesion-to-pancreas contrast ratio (CR). Results: High-resolution, high b-value computed DWI (r-cDWI1000) enabled significant improvement in lesion detection and a higher incidence of a high lesion-to-pancreas intensity relation (type 1, clear hyperintense) compared to conventional high b-value computed and high-resolution high b-value acquired DWI (f-cDWI1000 and r-aDWI1000, respectively). Image quality was rated inferior in the r-cDWI1000 datasets compared to r-aDWI1000. Furthermore, the aCNR and CR were higher in the r-cDWI1000 datasets than in f-cDWI1000 and r-aDWI1000. Conclusion: High-resolution, high b-value computed DWI provides significantly better visualization of PDAC compared to the conventional high b-value computed and high-resolution high b-value images acquired by DWI. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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9 pages, 2315 KiB

Open AccessArticle

Duration of Reduced CA19-9 Levels Is a Better Prognostic Factor Than Its Rate of Reduction for Unresectable Locally Advanced Pancreatic Cancer

by Ko Tomishima, Shigeto Ishii, Toshio Fujisawa, Muneo Ikemura, Hiroto Ota, Daishi Kabemura, Mako Ushio, Taito Fukuma, Sho Takahashi, Wataru Yamagata, Yusuke Takasaki, Akinori Suzuki, Koichi Ito, Hiroaki Saito, Akihito Nagahara and Hiroyuki Isayama

Cancers 2021, 13(16), 4224; https://doi.org/10.3390/cancers13164224 - 22 Aug 2021

Cited by 10 | Viewed by 6284

Abstract

A decrease in carbohydrate antigen (CA) 19-9 levels has been proposed as a prognostic marker for survival and recurrence in patients with pancreatic cancer. We evaluated the association between duration of reduced CA 19-9 levels during 6 months after treatment and long-term survival for 79 patients with unresectable locally advanced pancreatic cancer (LAPC). We calculated the differences between pretreatment and monthly CA19-9 levels. We categorized 71 patients with decreases in CA19-9 levels into three groups based on the duration of these reduced levels (>2, >3, and >4 months). The cut-off level for long-term (more than 2 years) survival was identified as a 44% reduction from the baseline, using a ROC curve. A reduction duration >2 months was not associated with overall survival (p = 0.1), while >3 months was significantly associated with survival (p =.04). In multivariate analysis, a reduction duration >3 months predicted a good long-term prognosis (odds ratio = 5.75; 95% confidence interval = 1.47–22.36; p < 0.01). In patients with unresectable LAPC, the duration of reduced CA19-9 levels for more than 3 months, rather than the rate of reduction in CA19-9 levels, during 6 months after treatment was significantly associated with good prognosis. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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13 pages, 2933 KiB

Open AccessFeature PaperArticle

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

by Jakob Liermann, Mustafa Syed, Edgar Ben-Josef, Kai Schubert, Ingmar Schlampp, Simon David Sprengel, Jonas Ristau, Fabian Weykamp, Manuel Röhrich, Stefan A. Koerber, Uwe Haberkorn, Juergen Debus, Klaus Herfarth, Frederik L. Giesel and Patrick Naumann

Cancers 2021, 13(4), 796; https://doi.org/10.3390/cancers13040796 - 14 Feb 2021

Cited by 36 | Viewed by 3525

Abstract

(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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12 pages, 547 KiB

Open AccessArticle

Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?

by Pauline Tortajada, Alain Sauvanet, Stephanie Truant, Nicolas Regenet, Régis Souche, Stéphane Benoist, Fabrice Muscari, Jean Marc Regimbeau, Sebastien Gaujoux, Antonio Sa Cunha, Lillian Schwarz and FRENCH-ACHBT Working Group

Cancers 2020, 12(10), 2814; https://doi.org/10.3390/cancers12102814 - 30 Sep 2020

Cited by 4 | Viewed by 1983

Abstract

(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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11 pages, 15630 KiB

Open AccessArticle

Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery

by Isao Numoto, Masakatsu Tsurusaki, Teruyoshi Oda, Yukinobu Yagyu, Kazunari Ishii and Takamichi Murakami

Cancers 2020, 12(10), 2733; https://doi.org/10.3390/cancers12102733 - 23 Sep 2020

Cited by 12 | Viewed by 2628 | Correction

Abstract

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding and complications, including pancreatitis, were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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9 pages, 788 KiB

Open AccessArticle

Assessment of Liver Metastases Using CT and MRI Scans in Patients with Pancreatic Ductal Adenocarcinoma: Effects of Observer Experience on Diagnostic Accuracy

by Masakatsu Tsurusaki, Isao Numoto, Teruyoshi Oda, Miyuki Wakana, Ayako Suzuki, Yukinobu Yagyu, Mitsuru Matsuki and Kazunari Ishii

Cancers 2020, 12(6), 1455; https://doi.org/10.3390/cancers12061455 - 3 Jun 2020

Cited by 8 | Viewed by 3339

Abstract

The aim of this study was to investigate the impact of radiologic experience on the diagnostic accuracy of computed tomography (CT) vs. magnetic resonance imaging (MRI) reporting on the liver metastases of pancreatic ductal adenocarcinoma (LM of PDAC). Intra-individual CT and MRI examinations of 112 patients with clinically proven LM of PDAC were included. Four radiologists with varying years of experience (A > 20, B > 5, C > 1 and D < 1) assessed liver segments affected by LM of PDAC, as well as associated metastases occurring in each patient. Their sensitivity and specificity in evaluating the segments were compared. Cohen’s Kappa (κ) for diagnosed liver segments and Intra-class Correlation Coefficients (ICC) for the number of metastatic lesions in each patient were calculated. The radiologists’ sensitivity and specificity for the CT vs. MRI were, respectively: Reader A—94.4%, 90.3% vs. 96.6%, 94.8%; B—86.7%, 79.7% vs. 83.9%, 82.0%; C—78.0%, 76.7% vs. 83.3%, 78.9% and D—71.8%, 79.2% vs. 64.0%, 69.5%. Reviewers A and B achieved greater agreement in assessing results from the MRI (κ = 0.72, p < 0.001; ICC = 0.73, p < 0.001) vs. the CT (κ = 0.58, p < 0.001; ICC = 0.61, p < 0.001), in contrast to readers C and D (MRI: κ = 0.34, p < 0.001; ICC = 0.42, p < 0.001, and CT: κ = 0.48, p < 0.001; ICC = 0.59, p < 0.001). Our results indicate that the accurate diagnosis of LM of PDAC depends more on radiologic experience in MRI over CT scans. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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Review

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22 pages, 12666 KiB

Open AccessReview

Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

by Ryota Sagami, Kentaro Yamao, Jun Nakahodo, Ryuki Minami, Masakatsu Tsurusaki, Kazunari Murakami and Yuji Amano

Cancers 2021, 13(5), 945; https://doi.org/10.3390/cancers13050945 - 24 Feb 2021

Cited by 22 | Viewed by 3685

Abstract

Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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2 pages, 448 KiB

Open AccessCorrection

Correction: Isao N., et al. Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or Following Pancreatic Surgery. Cancers 2020, 12, 2733

by Isao Numoto, Masakatsu Tsurusaki, Teruyoshi Oda, Yukinobu Yagyu, Kazunari Ishii and Takamichi Murakami

Cancers 2021, 13(6), 1312; https://doi.org/10.3390/cancers13061312 - 15 Mar 2021

Viewed by 1414

Abstract

The authors are sorry to report that the overall survival reported in their recently published paper was incorrect [...] Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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12 pages, 2151 KiB

Open AccessSystematic Review

Comparison of the Diagnostic Efficiency of Radial- and Convex-Arrayed Echoendoscopes for Indirect Findings of Pancreatic Cancer: A Retrospective Comparative Study Using Propensity Score Method

by Yuki Ishikawa-Kakiya, Hirotsugu Maruyama, Kei Yamamoto, Masafumi Yamamura, Kojiro Tanoue, Akira Higashimori, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Noriko Kamata, Yasuaki Nagami, Koichi Taira, Masatsugu Shiba, Toshio Watanabe and Yasuhiro Fujiwara

Cancers 2021, 13(6), 1217; https://doi.org/10.3390/cancers13061217 - 11 Mar 2021

Cited by 4 | Viewed by 2517

Abstract

Endoscopic ultrasonography (EUS) is useful for detecting early-stage pancreatic cancer. Because the detection of small lesions is difficult, it is important to detect indirect findings, namely caliber change, retention cysts, and dilatation of the branch duct, during the procedure. Although two types of EUS endoscopes are frequently used, there is no comparative study on their efficacy for detecting indirect findings. Therefore, we aimed to compare the diagnostic efficacy of these two types for indirect findings. We retrospectively analyzed 316 consecutive patients who had undergone EUS for pancreaticobiliary disease at a single center between January 2017 and December 2018. The main outcome was the detection rate of indirect findings and its comparison between the two echoendoscope types. This outcome was achieved using the inverse probability of treatment weighting (IPTW) analysis. The detection rate of indirect findings was higher for the radial-arrayed endoscope than for the convex-arrayed echoendoscope (9.2% vs. 2.3% (p = 0.02)). The univariate analysis also revealed that the radial-arrayed echoendoscope was significantly superior to the convex-arrayed echoendoscope in terms of the detection of indirect findings (odds ratio, 5.94; 95% confidence interval, 1.68–21.10; p = 0.01) after IPTW. After adjustment for magnetic resonance imaging (MRI) and computed tomography (CT), radial-arrayed echoendoscope remained an independent factor for indirect finding detection (odds ratio, 6.04; 95% confidence interval, 1.74–21.00; p = 0.01). Finally, five patients who had indirect EUS findings were diagnosed with pancreatic cancer. Our results indicate that the radial-arrayed echoendoscope is useful for the detection of indirect findings. Full article

(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)

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