Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology, Yonsei Biomedical Research Institute, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2019 Jan;51(1):24-33. doi: 10.4143/crt.2017.404. Epub 2018 Feb 5.
The purpose of this study was to investigate the impact of contrast enhanced pancreatic magnetic resonance imaging (MRI) in resectability and prognosis evaluation after staging computed tomography (CT) in patients with pancreatic ductal adenocarcinoma (PDA).
From January 2005 to December 2012, 298 patients were diagnosed to have potentially resectable stage PDA on CT. Patients were divided into CT+MR (patients underwent both CT and MRI; n=216) and CT only groups (n=82). Changes in resectability staging in the CT+MR group were evaluated. The overall survival was compared between the two groups. The recurrence-free survival and median time to liver metastasis after curative surgery were compared between the two groups.
Staging was changed from resectable on CT to unresectable state on MRI in 14.4% of (31 of 216 patients) patients of the CT+MR group. The overall survival and recurrence-free survival rates were not significantly different between the two groups (p=0.162 and p=0.721, respectively). The median time to liver metastases after curative surgery in the CT+MR group (9.9 months) was significantly longer than that in the CT group (4.2 months) (p=0.011).
Additional MRI resulted in changes of resectability and treatment modifications in a significant proportion of patients who have potentially resectable state at CT and in prolonged time to liver metastases in patients after curative surgery. Additional MRI to standard staging CT can be recommended for surgical candidates of PDA.
本研究旨在探讨增强型胰腺磁共振成像（MRI）对经分期 CT 检查诊断为胰腺导管腺癌（PDA）且具有潜在可切除性的患者进行可切除性和预后评估的影响。
2005 年 1 月至 2012 年 12 月，298 例患者经 CT 检查诊断为 PDA 且具有潜在可切除性。将患者分为 CT+MR（同时行 CT 和 MRI 检查，n=216）组和 CT 组（n=82）。评估 CT+MR 组中可切除性分期的变化。比较两组患者的总生存期。比较两组根治性手术后的无复发生存率和中位肝转移时间。
在 CT+MR 组中，有 14.4%（31/216 例）的患者由 CT 可切除变为 MRI 不可切除。两组患者的总生存期和无复发生存率差异均无统计学意义（p=0.162 和 p=0.721）。CT+MR 组根治性手术后中位肝转移时间（9.9 个月）明显长于 CT 组（4.2 个月）（p=0.011）。
在 CT 检查提示具有潜在可切除性的患者中，有相当比例的患者因额外行 MRI 而改变了可切除性和治疗方式，且根治性手术后患者的中位肝转移时间延长。对于 PDA 的手术候选者，建议在标准分期 CT 之外增加 MRI。
