Miriam Klauß1, Wolfram Stiller1, Philipp Mayer2, Franziska Fritz1, Marco Koell1, Stephan Skornitzke1, Frank Bergmann3, Matthias M Gaida4, Thilo Hackert5, Klaus Maier-Hein6, Frederik B Laun7,8, Hans-Ulrich Kauczor1, Lars Grenacher1,9. 1. Clinic for Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. 2. Clinic for Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. Philipp.Mayer@med.uni-heidelberg.de. 3. Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany. 4. Institute of Pathology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. 5. Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. 6. Department of Medical Imaging Computing, German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany. 7. Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany. 8. Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany. 9. Conradia Radiology Munich, Augustenstraße 115, 80798, Munich, Germany.
Abstract
BACKGROUND/ OBJECTIVES: The aim of this study was to compare intravoxel incoherent motion (IVIM) diffusion weighted (DW) MRI and CT perfusion to assess tumor perfusion of pancreatic ductal adenocarcinoma (PDAC). METHODS: In this prospective study, DW-MRI and CT perfusion were conducted in nineteen patients with PDAC on the day before surgery. IVIM analysis of DW-MRI was performed and the parameters perfusion fraction f, pseudodiffusion coefficient D*, and diffusion coefficient D were extracted for tumors, upstream, and downstream parenchyma. With a deconvolution-based analysis, the CT perfusion parameters blood flow (BF) and blood volume (BV) were estimated for tumors, upstream, and downstream parenchyma. In ten patients, intratumoral microvessel density (MVDtumor) and microvessel area (MVAtumor) were analyzed microscopically in resection specimens. Correlation coefficients between IVIM parameters, CT perfusion parameters, and histological microvessel parameters in tumors were calculated. Receiver operating characteristic (ROC) analysis was performed for differentiation of tumors and upstream parenchyma. RESULTS: ftumor significantly positively correlated with BFtumor (r = 0.668, p = 0.002) and BVtumor (r = 0.672, p = 0.002). There were significant positive correlations between ftumor and MVDtumor/ MVAtumor (r ≥ 0.770, p ≤ 0.009) as well as between BFtumor and MVDtumor/ MVAtumor (r ≥ 0.697, p ≤ 0.025). Correlation coefficients between ftumor and MVDtumor/ MVAtumor were not significantly different from correlation coefficients between BFtumor and MVDtumor/ MVAtumor (p ≥ 0.400). Moreover, f, BF, BV, and permeability values (PEM) showed excellent performance in distinguishing tumors from upstream parenchyma (area under the ROC curve ≥0.874). CONCLUSIONS: The study shows that IVIM derived ftumor and CT perfusion derived BFtumor similarly reflect vascularity of PDAC and seem to be comparably applicable for the evaluation of tumor perfusion for tumor characterization and as potential quantitative imaging biomarker. TRIAL REGISTRATION: DRKS, DRKS00022227, Registered 26 June 2020, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00022227.
BACKGROUND/ OBJECTIVES: The aim of this study was to compare intravoxel incoherent motion (IVIM) diffusion weighted (DW) MRI and CT perfusion to assess tumor perfusion of pancreatic ductal adenocarcinoma (PDAC). METHODS: In this prospective study, DW-MRI and CT perfusion were conducted in nineteen patients with PDAC on the day before surgery. IVIM analysis of DW-MRI was performed and the parameters perfusion fraction f, pseudodiffusion coefficient D*, and diffusion coefficient D were extracted for tumors, upstream, and downstream parenchyma. With a deconvolution-based analysis, the CT perfusion parameters blood flow (BF) and blood volume (BV) were estimated for tumors, upstream, and downstream parenchyma. In ten patients, intratumoral microvessel density (MVDtumor) and microvessel area (MVAtumor) were analyzed microscopically in resection specimens. Correlation coefficients between IVIM parameters, CT perfusion parameters, and histological microvessel parameters in tumors were calculated. Receiver operating characteristic (ROC) analysis was performed for differentiation of tumors and upstream parenchyma. RESULTS: ftumor significantly positively correlated with BFtumor (r = 0.668, p = 0.002) and BVtumor (r = 0.672, p = 0.002). There were significant positive correlations between ftumor and MVDtumor/ MVAtumor (r ≥ 0.770, p ≤ 0.009) as well as between BFtumor and MVDtumor/ MVAtumor (r ≥ 0.697, p ≤ 0.025). Correlation coefficients between ftumor and MVDtumor/ MVAtumor were not significantly different from correlation coefficients between BFtumor and MVDtumor/ MVAtumor (p ≥ 0.400). Moreover, f, BF, BV, and permeability values (PEM) showed excellent performance in distinguishing tumors from upstream parenchyma (area under the ROC curve ≥0.874). CONCLUSIONS: The study shows that IVIM derived ftumor and CT perfusion derived BFtumor similarly reflect vascularity of PDAC and seem to be comparably applicable for the evaluation of tumor perfusion for tumor characterization and as potential quantitative imaging biomarker. TRIAL REGISTRATION: DRKS, DRKS00022227, Registered 26 June 2020, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00022227.
Authors: Marco Niedergethmann; Ralf Hildenbrand; Birgit Wostbrock; Mark Hartel; Jörg W Sturm; Axel Richter; Stefan Post Journal: Pancreas Date: 2002-08 Impact factor: 3.327
Authors: N Ikeda; M Adachi; T Taki; C Huang; H Hashida; A Takabayashi; M Sho; Y Nakajima; H Kanehiro; M Hisanaga; H Nakano; M Miyake Journal: Br J Cancer Date: 1999-03 Impact factor: 7.640
Authors: Muhammad S Alam; Matthias M Gaida; Frank Bergmann; Felix Lasitschka; Thomas Giese; Nathalia A Giese; Thilo Hackert; Ulf Hinz; S Perwez Hussain; Serguei V Kozlov; Jonathan D Ashwell Journal: Nat Med Date: 2015-10-19 Impact factor: 53.440