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Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer Cover

Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer

Radiology and Oncology
Volume 53 (2019): Issue 1 (March 2019)
By: Vincenza Granata,  Roberta Fusco,  Sergio Venanzio Setola,  Raffaele Palaia,  Vittorio Albino,  Mauro Piccirillo,  Robert Grimm,  Antonella Petrillo and  Francesco Izzo  
Open Access
|Jan 2019

Figures & Tables

Figure 1

Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters pre and post treatment values between responders and not responders. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters pre and post treatment values between responders and not responders. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 2

Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters percentage change values between responders and not responders. Delta (Δ) = percentage change between pre and post treatment; MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters percentage change values between responders and not responders. Delta (Δ) = percentage change between pre and post treatment; MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 3

ROC curve of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) features to assess electrochemotherapy (ECT) response. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
ROC curve of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) features to assess electrochemotherapy (ECT) response. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 4

Adenocarcinoma of the pancreatic head. Before treatment in (A) (half-Fourier acquisition single-shot turbo spin-echo [HASTE] T2- Weighted [W] sequence), the lesion (arrow) appears hyperintense, in (B) (in-phase T1-W sequence) and (C) (out-phase T1-W sequence) appears hypointense and hypovascular in (D) (volumetric interpolated breath hold examination [VIBE] T1-W in equilibrium phase). After the treatment the lesion in (E) (HASTE T2-W sequence), (F) (in-phase T1-W sequence), (G) (out-phase T1-W sequence) and (H) (VIBE T1-W in equilibrium phase): there were not significant differences in size and signal compared to baseline. Apparent diffusion coefficient (ADC) map before and after treatment (I, J).
Adenocarcinoma of the pancreatic head. Before treatment in (A) (half-Fourier acquisition single-shot turbo spin-echo [HASTE] T2- Weighted [W] sequence), the lesion (arrow) appears hyperintense, in (B) (in-phase T1-W sequence) and (C) (out-phase T1-W sequence) appears hypointense and hypovascular in (D) (volumetric interpolated breath hold examination [VIBE] T1-W in equilibrium phase). After the treatment the lesion in (E) (HASTE T2-W sequence), (F) (in-phase T1-W sequence), (G) (out-phase T1-W sequence) and (H) (VIBE T1-W in equilibrium phase): there were not significant differences in size and signal compared to baseline. Apparent diffusion coefficient (ADC) map before and after treatment (I, J).

MRI protocol parameters

SequenceOrientationTR/TE/FA (ms/ms/deg.)FOV (mm2)Acquisition matrixSlice thickness/ gap (mm)
HASTE T2-WAxial1500/90/180380 × 380320 × 3205/0
FLASH T1-W, In-out phaseAxial160/4.87/70285 × 380192 × 2565/0
FLASH T1-W, out phaseAxial178/2.3/80325 × 400416 × 4123/0
DWIAxial7500/91/90340 × 340192 × 1923/0
VIBE T1-WAxial4.89/2.38/10325 × 400320 × 2603/0
TWIST T1-W, Pre and post contrast agent injectionAxial3.01/1.09/25300 × 300256 × 2562/0

Electrochemotherapy (ECT) response classification for each patient

No.CT response according ChoiDCE-MRI response according ΔWIS and ΔWOSPET response according PERCISTConsenssus among two modalities
1PRPRPDPR
2PRPR PR
3PRPRPRPR
4PRPR PR
10PR CRPR
11PRSDPRSD
12SDPRSDSD
13PRSDPRPR
14PRPRPRPR
17PRPRSDPR
18PRPRSDPR
19PRPR/SDPRPR
20PRPR PR
21SDSD SD

Diagnostic accuracy of MRI extracted parameters in discrimination of responders and not responders_

AUC95% CIp valueSensitivitySpecificityCut-off
ΔADC0,7670,429–1,000,1760,9000,667-25,775
ΔMK0,5330,229–0,8370,8660,5001,00014,555
ΔMD0,9330,782–1,0000,0280,8001,000-32,570
ADC PRE0,6670,292–1,0000,3980,7000,6671182,550
MK PRE0,6670,380–1,9530,3980,6001,0001348,700
MD PRE0,7000,360–1,0000,3100,4001,0002477,500
ADC POST0,3670,000–0,7660,4990,8000,3331177,825
MK POST0,8000,505–1,0000,1280,5001,0001299,075
MD POST0,2670,000–0,6020,2370,6000,3332020,725

Patients’ characteristics

Patients (n = 21)
Histotype, %
Adenocarcinoma100 (21/21)
Location, %
Head52.4 (11/21)
Body/tail47.6 (10/21)
Largest diameter lesion, cm (range)5.2 (2.2–9.9)
Venus involvement (superior mesenteric vein [SMV] or portal vein [PV]), %
Yes81.0 (17/21)
No19.0 (4/21)
Arterial encasement, %
Yes57.1 (12/21)
No42.9 (9/21)
DOI: https://doi.org/10.2478/raon-2019-0004 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 15 - 24
Submitted on: Sep 24, 2018
|
Accepted on: Nov 18, 2018
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Published on: Jan 19, 2019
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
pancreatic cancer,
electrochemotherapy,
magnetic resonance imaging,
diffusion weighted imaging,
diffusion kurtosis imaging
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2019 Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Raffaele Palaia, Vittorio Albino, Mauro Piccirillo, Robert Grimm, Antonella Petrillo, Francesco Izzo, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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