Kim Hyoung Woo, Lee Jong-Chan, Paik Kyu-Hyun, Kang Jingu, Kim Young Hoon, Yoon Yoo-Seok, Han Ho-Seong, Kim Jaihwan, Hwang Jin-Hyeok
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Surgery. 2017 Jun;161(6):1579-1587. doi: 10.1016/j.surg.2016.12.038. Epub 2017 Feb 23.
The adjunctive role of magnetic resonance imaging of the liver before pancreatic ductal adenocarcinoma has been unclear. We evaluated whether the combination of hepatic magnetic resonance imaging with multidetector computed tomography using a pancreatic protocol (pCT) could help surgeons select appropriate candidates and decrease the risk of early recurrence.
We retrospectively enrolled 167 patients in whom complete resection was achieved without grossly visible residual tumor; 102 patients underwent pCT alone (CT group) and 65 underwent both hepatic magnetic resonance imaging and pCT (magnetic resonance imaging group).
By adding hepatic magnetic resonance imaging during preoperative evaluation, hepatic metastases were newly discovered in 3 of 58 patients (5%) without hepatic lesions on pCT and 17 of 53 patients (32%) with indeterminate hepatic lesions on pCT. Patients with borderline resectability, a tumor size >3 cm, or preoperative carbohydrate antigen 19-9 level >1,000 U/mL had a greater rate of hepatic metastasis on subsequent hepatic magnetic resonance imaging. Among 167 patients in whom R0/R1 resection was achieved, the median overall survival was 18.2 vs 24.7 months (P = .020) and the disease-free survival was 8.5 vs 10.0 months (P = .016) in the CT and magnetic resonance imaging groups, respectively (median follow-up, 18.3 months). Recurrence developed in 82 (80%) and 43 (66%) patients in the CT and magnetic resonance imaging groups, respectively. The cumulative hepatic recurrence rate was greater in the CT group than in the magnetic resonance imaging group (P < .001).
Preoperative hepatic magnetic resonance imaging should be considered in patients with potentially resectable pancreatic ductal adenocarcinoma, especially those with high tumor burden.
肝脏磁共振成像在胰腺导管腺癌术前的辅助作用尚不清楚。我们评估了肝脏磁共振成像与采用胰腺方案的多排螺旋计算机断层扫描（pCT）相结合是否有助于外科医生选择合适的患者，并降低早期复发风险。
我们回顾性纳入了167例实现了完全切除且无肉眼可见残留肿瘤的患者；102例患者仅接受了pCT（CT组），65例患者同时接受了肝脏磁共振成像和pCT（磁共振成像组）。
通过在术前评估中增加肝脏磁共振成像，在pCT上无肝脏病变的58例患者中有3例（5%）新发现了肝转移，在pCT上肝脏病变不确定的53例患者中有17例（32%）新发现了肝转移。具有临界可切除性、肿瘤大小>3 cm或术前糖类抗原19-9水平>1000 U/mL的患者在后续肝脏磁共振成像上肝转移率更高。在167例实现了R0/R1切除的患者中，CT组和磁共振成像组的中位总生存期分别为18.2个月和24.7个月（P = 0.020），无病生存期分别为8.5个月和10.0个月（P = 0.016）（中位随访时间为18.3个月）。CT组和磁共振成像组分别有82例（80%）和43例（66%）患者出现复发。CT组的累积肝复发率高于磁共振成像组（P < 0.001）。
对于潜在可切除的胰腺导管腺癌患者，尤其是肿瘤负荷高的患者，应考虑术前行肝脏磁共振成像检查。
