MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications

Raghavan, Kesav; Jeffrey, R. Brooke; Patel, Bhavik N.; DiMaio, Michael A.; Willmann, Jürgen K.; Olcott, Eric W.

doi:10.2214/ajr.15.14607

Cited by 13 publications

(5 citation statements)

References 26 publications

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“…Unfortunately, 20%-30% of patients who undergo resection will die within 12 months, even if they receive adjuvant therapy (6). Although the surgical mortality rate for pancreaticoduodenectomy has decreased to only 1%-2% in recent years, the morbidity of this procedure remains high, in the range of 20%-30% 1,7, and many patients harbor undetected GASTROINTESTINAL IMAGING: Extrapancreatic Perineural or Duodenal Invasion at Multidetector CT Chang et al were evaluated for the presence or absence of duodenal invasion and EPNI, by using findings described earlier (14)(15)(16)(17)23), and for the presence of resectable disease, with the imaging criteria defined above. Images were evaluated by two abdominal radiologists, one (R.B.J.)…”

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confidence: 99%

Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care

Chang¹,

Jeffrey²,

Patel³

et al. 2016

Radiology

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Purpose To test the hypothesis that patients with pancreatic adenocarcinoma who otherwise are viewed to have resectable disease but have preoperative findings of extrapancreatic perineural invasion (EPNI) and/or duodenal invasion at multidetector computed tomography (CT) have reduced postoperative survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). Materials and Methods This study was approved by the institutional review board and complied with HIPAA. The authors retrospectively evaluated 76 consecutive patients with PDAC who underwent preoperative multidetector CT and subsequent pancreaticoduodenectomy. Two radiologists blinded to surgical pathology results and clinical outcome evaluated multidetector CT images for evidence of EPNI and duodenal invasion; discrepancies were resolved by consensus. Also determined for each patient were resected lymph node status, tumor size, surgical margin status, time to progression, and time to death. Data were assessed with the Goodman-Kruskal gamma for correlations among indicators and the log-rank test, Kaplan-Meier estimates, and multivariate Cox proportional hazards regression for survival analysis. Results In univariate analysis, duodenal invasion and/or EPNI on preoperativemultidetector CT images was associated with significantly decreased progression-free survival (P < .0001) and overall survival (P = .0013), and the clinical indicators (lymph node status, tumor size, and surgical margin status) as well as duodenal invasion and/or EPNI showed correlation with each other. In multivariate regression that included multidetector CT findings as well as the three traditional clinical indicators, only duodenal invasion and/or EPNI showed significant independent association with reduction in both modes of survival (P < .0001 and P = .014, respectively). Interobserver agreement was substantial with respect to EPNI and duodenal invasion (κ = 0.691 and 0.682, respectively). Conclusion Patients with evidence of EPNI and/or duodenal invasion on preoperative multidetector CT images have significantly reduced survival after pancreaticoduodenectomy for PDAC. RSNA, 2016.

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Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care

Chang¹,

Jeffrey²,

Patel³

et al. 2016

Radiology

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“…found that enhancement of greater than two-thirds of the primary lesion on delayed phase images was correlated with PNI in 32 patients with intrahepatic cholangiocarcinoma (ICC) ( 33 ). But this conclusion was not confirmed in another study, in which soft-tissue infiltration along the celiac plexus on MDCT was regarded as an indicator of PNI in 20 ICC patients ( 34 ). In addition, several studies have shown the value of 3D volume-rendered MDCT imaging in diagnosing PNI of pancreatic adenocarcinoma ( 35 , 36 ).…”

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confidence: 82%

CT-Based Radiomics Analysis for Noninvasive Prediction of Perineural Invasion of Perihilar Cholangiocarcinoma

Zhan

Lyu

et al. 2022

Front. Oncol.

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PurposeThe study aimed to construct and evaluate a CT-Based radiomics model for noninvasive detecting perineural invasion (PNI) of perihilar cholangiocarcinoma (pCCA) preoperatively.Materials and MethodsFrom February 2012 to October 2021, a total of 161 patients with pCCA who underwent resection were retrospectively enrolled in this study. Patients were allocated into the training cohort and the validation cohort according to the diagnostic time. Venous phase images of contrast-enhanced CT were used for radiomics analysis. The intraclass correlation efficient (ICC), the correlation analysis, and the least absolute shrinkage and selection operator (LASSO) regression were applied to select radiomics features and built radiomics signature. Logistic regression analyses were performed to establish a clinical model, a radiomics model, and a combined model. The performance of the predictive models was measured by area under the receiver operating characteristic curve (AUC), and pairwise ROC comparisons between models were tested using the Delong method. Finally, the model with the best performance was presented as a nomogram, and its calibration and clinical usefulness were assessed.ResultsFinally, 15 radiomics features were selected to build a radiomics signature, and three models were developed through logistic regression. In the training cohort, the combined model showed a higher predictive capability (AUC = 0.950) than the radiomics model and the clinical model (AUC: radiomics = 0.914, clinical = 0.756). However, in the validation cohort, the AUC of the radiomics model (AUC = 0.885) was significantly higher than the other two models (AUC: combined = 0.791, clinical = 0.567). After comprehensive consideration, the radiomics model was chosen to develop the nomogram. The calibration curve and decision curve analysis (DCA) suggested that the nomogram had a good consistency and clinical utility.ConclusionWe developed a CT-based radiomics model with good performance to noninvasively predict PNI of pCCA preoperatively.

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“…The efficacy of these procedures relies on precise targeting of the celiac plexus [19], which shows considerable anatomical variability [20]. In addition, improved neurographic image quality in this anatomical region could also be of added value for tumour staging [21, 22].…”

Section: Discussionmentioning

confidence: 99%

Respiratory- and cardiac-triggered three-dimensional sheath inked rapid acquisition with refocused echoes imaging (SHINKEI) of the abdomen for magnetic resonance neurography of the celiac plexus

Ferrer

Bos

Yoneyama³

et al. 2019

Eur Radiol Exp

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The visualisation of the celiac plexus using respiratory- and cardiac-triggered three-dimensional (3D) sheath inked rapid acquisition with refocused echoes imaging (SHINKEI) was evaluated. After ethical approval and written informed consent, eight volunteers (age 27 ± 5 years, mean ± standard deviation) were scanned at 1.5 and 3 T. Displacement of the celiac ganglia due to aortic pulsatility was studied on axial single-slice breath-hold balanced turbo field-echo cine sequences in five volunteers and found to be 3.0 ± 0.5 mm (left) and 3.1 ± 0.4 mm (right). Respiratory- and cardiac-triggered 3D SHINKEI images were compared to respiratory- and cardiac-triggered fat-suppressed 3D T2-weighted turbo spin-echo and respiratory-triggered 3D SHINKEI in all volunteers. Visibility of the celiac ganglia was rated by three radiologists as visible or non-visible. On 3D SHINKEI with double-triggering at 1.5 T, the left and right ganglia were seen by all observers in 7/8 and 8/8 volunteers, respectively. At 3 T, this was the case for 6/8 and 7/8 volunteers, respectively. The nerve-to-muscle signal ratio increased from 1.9 ± 0.5 on fat-suppressed 3D T2-weighted turbo spin-echo to 4.7 ± 0.8 with 3D SHINKEI. Anatomical validation was performed in a human cadaver. An expert in anatomy confirmed that the hyperintense structure visible on ex vivo 3D SHINKEI scans was the celiac plexus. In conclusion, double-triggering allowed visualisation of the celiac plexus using 3D SHINKEI at both 1.5 T and 3 T.

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MDCT Diagnosis of Perineural Invasion Involving the Celiac Plexus in Intrahepatic Cholangiocarcinoma: Preliminary Observations and Clinical Implications

Cited by 13 publications

References 26 publications

Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care

Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care

CT-Based Radiomics Analysis for Noninvasive Prediction of Perineural Invasion of Perihilar Cholangiocarcinoma

Respiratory- and cardiac-triggered three-dimensional sheath inked rapid acquisition with refocused echoes imaging (SHINKEI) of the abdomen for magnetic resonance neurography of the celiac plexus

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