PET/MRI for evaluation of patients with pancreatic cancer

Duncan, Zoey; Summerlin, David; West, Janelle T.; Packard, Ann T.; Morgan, Desiree E.; Galgano, Samuel J.

doi:10.1007/s00261-023-03943-9

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…This may be because PET/MRI has better resolution when detecting regional sites. 23 Overall, our findings suggest that PET/MRI is a better option for detecting metastases compared with PET/CT, specifically when assessing for hepatic metastases, in high-risk populations or whenever it is feasible and available, specifically if there are suspicious or indeterminate lesions on standard pancreatic protocol CT. It is crucial to highlight that advancements in technology are consistently enhancing both PET/MRI and PET/CT.…”

Section: Discussionmentioning

confidence: 71%

Baseline Characteristics and Use of Pretherapeutic 18F-Fluorodeoxyglucose-PET for Pancreatic Cancer

Carlson,

Abdelrahman,

Adjei Antwi

et al. 2024

Journal of the American College of Surgeons

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Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and lethal malignancy. Surgical resection is the only curative modality combined with neoadjuvant chemotherapy to improve survival. Given the limitations of traditional responses like cross-sectional imaging (CT/MRI) or tumor markers, carbohydrate antigen 19-9 (CA19-9), the 2023 National Comprehensive Cancer Network (NCCN) guidelines included fluorodeoxyglucose-positron emission tomography (FDG-PET) as an adjunct to assess response to neoadjuvant chemotherapy. There are common misconceptions on the metabolic activity (tumor avidity) in PDAC, so we aimed to describe the baseline characteristics and utility of FDG-PET in a cohort of treatment naïve PDAC patients. Methods: A single center retrospective study was conducted capturing all biopsy proven, treatment naïve PDAC patients that underwent either baseline FDG-PET/CT or FDG-PET/MRI imaging between (2008-2023). Baseline FDG-PET characteristics were collected, including primary tumors’ maximum standardized uptake value (SUVmax) defined as metabolic activity (FDG uptake) of tumor compared to surrounding pancreatic parenchymal background, and the identification of extra-pancreatic metastatic disease. Results We identified 1095 treatment naïve PDAC patients that underwent baseline FDG-PET imaging at diagnosis. CA19-9 was elevated in 76% of patients. Overall, 96.3% (n=1054) of patients had FDG-avid tumors with a median SUVmax of 6.4. FDG-PET also identified suspicious extrapancreatic metastatic lesions in 50% of patients, with a higher proportion (p < 0.001) in PET/MRI (59.9%) vs. PET/CT (44.3%). After controlling for CA19-9 elevation, PET/MRI was superior in detection of extrapancreatic lesions compared to PET/CT. Conclusion: FDG-PET has significant utility in PDAC as a baseline imaging modality prior neoadjuvant therapy given the majority of tumors are FDG avid. Furthermore, FDG-PET can identify additional extrapancreatic suspicious lesions allowing for optimal initial staging, with PET/MRI having increased sensitivity over PET/CT.

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Section: Discussionmentioning

confidence: 71%

Baseline Characteristics and Use of Pretherapeutic 18F-Fluorodeoxyglucose-PET for Pancreatic Cancer

Carlson,

Abdelrahman,

Adjei Antwi

et al. 2024

Journal of the American College of Surgeons

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Pancreatic ductal adenocarcinoma staging: a narrative review of radiologic techniques and advances

Chu,

Fishman

2023

International Journal of Surgery

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Radiology plays an important role in the initial diagnosis and staging of patients with pancreatic ductal adenocarcinoma (PDAC). CT is the preferred modality over MRI, due to wider availability, greater consistency in image quality, and lower cost. MRI and PET/CT are usually reserved as problem-solving tools in select patients. The National Comprehensive Cancer Network (NCCN) guidelines define resectability criteria based on tumor involvement of the arteries and veins, and triage patients into resectable, borderline resectable, locally advanced, and metastatic categories. Patients with resectable disease are eligible for upfront surgical resection, while patients with high-stage disease are treated with neoadjuvant chemotherapy and/or radiation therapy with hopes of downstaging the disease. The accuracy of staging critically depends on imaging technique and the experience of the radiologists. Several challenges in accurate preoperative staging include prediction of lymph node metastases, detection of subtle liver and peritoneal metastases, and disease restaging following neoadjuvant therapy. Artificial intelligence (AI) has the potential to function as “second readers” to improve upon the radiologists’ detection of small early-stage tumors, which can shift more patients toward surgical resection of potentially curable cancer. AI may also provide imaging biomarkers that can predict disease recurrence and patient survival after pancreatic resection and assist in selection of patients most likely to benefit from surgery thus improving patient outcomes.

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PET/MRI for evaluation of patients with pancreatic cancer

Cited by 2 publications

References 38 publications

Baseline Characteristics and Use of Pretherapeutic 18F-Fluorodeoxyglucose-PET for Pancreatic Cancer

Baseline Characteristics and Use of Pretherapeutic 18F-Fluorodeoxyglucose-PET for Pancreatic Cancer

Pancreatic ductal adenocarcinoma staging: a narrative review of radiologic techniques and advances

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