Diagnosis and Staging of Pancreatic Cancer: Comparison of Mangafodipir Trisodium—Enhanced MR Imaging and Contrast-Enhanced Helical Hydro-CT

Abstract

Mangafodipir trisodium-enhanced MR imaging is as accurate as contrast-enhanced helical CT for the detection and staging of pancreatic cancer but offers improved detection of small pancreatic metastases and of liver metastases compared with CT.

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

“…It was in a comparable but not that high of a range compared with previous reports, but was nevertheless beyond our expectations (11,14,41). One reason for this is the decreased specificity for resectability caused by unexpected small (Ͻ 1 cm in diameter) liver metastasis (n ϭ 2) which was not even detected on retrospective review of the images.…”

“…One reason for this is the decreased specificity for resectability caused by unexpected small (Ͻ 1 cm in diameter) liver metastasis (n ϭ 2) which was not even detected on retrospective review of the images. Although the superiority of contrast-enhanced MR over CT for detecting hepatic metastasis has already been previously reported, it can be further improved with the use of liver specific MR contrast media (especially with hepatobiliary agents) (11,23), although unexpected hepatic metastasis is still problematic in clinical practice (15). Studies of mangafodipir trisodium-enhanced MR imaging have shown improved tumor delineation and diagnostic confidence as well as improved detection of small (Ͻ 2 cm) liver metastasis compared with singledetector helical CT (11,26,42).…”

“…Pancreatic adenocarcinoma was defined on T1W MR and CT as a hypointense lesion or as a hypoattenuating lesion that showed less or no enhancement relative to the normal peripheral pancreatic parenchyma, respectively (11). Regarding the tumor detection and conspicuity evaluation, the readers classified the conspicuity of lesions in the pancreas on a 5-point confidence scale (1 ϭ definitely not delineated, 2 ϭ probably not delineated, 3 ϭ indeterminate, 4 ϭ probably delineated, and 5 ϭ definitely delineated) for each image set.…”

“…A tumor was considered unresectable if one of the following findings was present: (i) distant metastasis: liver, peritoneum, para-aortic lymph nodes, or lung; (ii) invasion into peripancreatic arteries: celiac trunk, hepatic artery, or SMA; (iii) massive venous invasion of portal vein and/or SMV, i.e., tumor infiltration with thrombosis and obliteration of the vessel lumen involving a segment longer than 2 cm; and (iv) infiltration in adjacent organs: stomach, spleen, or colon (11). Limited invasion, that is, less than a 2-cm segment, of the portal vein or the SMV was not considered an absolute contraindication to surgery because a radical tumor resection with venous reconstruction can be performed by our surgeons (10,33).…”

“…However, with recent MR technological developments such as parallel acquisition imaging, high performance gradient phased array coils as well as rapid imaging sequences, MR developed into a useful imaging modality for the abdomen (21,22). Several previous studies have shown promising results using contrast-enhanced MRI using two-dimensional (2D) gradient-recalled echo (GRE) sequence for the detection and staging of pancreas cancer compared with those of CT (11,(23)(24)(25)(26), while some authors maintain that CT is superior to MRI (14,(27)(28)(29). Furthermore, recently developed three-dimensional (3D) GRE MR and 3D MRCP have led to improved visualization of the pancreatobiliary system by allowing higher spatial resolution and higher contrast resolution with reduced phase artifact and partial volume artifacts compared with 2D-GRE MRI or 2D MRCP (30).…”