Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 4032, Kansas City, KS, 66160, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 2Nd Floor, Pasadena, CA, 91101, USA.
Abdom Radiol (NY). 2024 May;49(5):1489-1501. doi: 10.1007/s00261-024-04271-2. Epub 2024 Apr 5.
Magnetic resonance imaging has been recommended as a primary imaging modality among high-risk individuals undergoing screening for pancreatic cancer. We aimed to delineate potential precursor lesions for pancreatic cancer on MR imaging.
We conducted a case-control study at Kaiser Permanente Southern California (2008-2018) among patients that developed pancreatic cancer who had pre-diagnostic MRI examinations obtained 2-36 months prior to cancer diagnosis (cases) matched 1:2 by age, gender, race/ethnicity, contrast status and year of scan (controls). Patients with history of acute/chronic pancreatitis or prior pancreatic surgery were excluded. Images underwent blind review with assessment of a priori defined series of parenchymal and ductal features. We performed logistic regression to assess the associations between individual factors and pancreatic cancer. We further assessed the interaction among features as well as performed a sensitivity analysis stratifying based on specific time-windows (2-3 months, 4-12 months, 13-36 months prior to cancer diagnosis).
We identified 141 cases (37.9% stage I-II, 2.1% III, 31.4% IV, 28.6% unknown) and 292 matched controls. A solid mass was noted in 24 (17%) of the pre-diagnostic MRI scans. Compared to controls, pre-diagnostic images from cancer cases more frequently exhibited the following ductal findings: main duct dilatation (51.4% vs 14.3%, OR [95% CI]: 7.75 [4.19-15.44], focal pancreatic duct stricture with distal (upstream) dilatation (43.6% vs 5.6%, OR 12.71 [6.02-30.89], irregularity (42.1% vs 6.0%, OR 9.73 [4.91-21.43]), focal pancreatic side branch dilation (13.6% vs1.6%, OR 11.57 [3.38-61.32]) as well as parenchymal features: atrophy (57.9% vs 27.4%, OR 46.4 [2.71-8.28], focal area of signal abnormality (39.3% vs 4.8%, OR 15.69 [6.72-44,78]), all p < 0.001).
In addition to potential missed lesions, we have identified a series of ductal and parenchymal features on MRI that are associated with increased odds of developing pancreatic cancer.
磁共振成像（MRI）已被推荐作为高危人群进行胰腺癌筛查的主要成像方式。本研究旨在描绘 MRI 上胰腺癌的潜在前驱病变。
我们在 Kaiser Permanente Southern California（2008-2018 年）进行了一项病例对照研究，纳入了在癌症诊断前 2-36 个月进行 MRI 检查且诊断为胰腺癌的患者（病例），并按照年龄、性别、种族/民族、造影剂使用情况和扫描年份匹配了 2:1 的对照（对照组）。排除了有急性/慢性胰腺炎或既往胰腺手术史的患者。对图像进行了盲法评估，并评估了一系列事先定义的实质和胰管特征。我们进行了逻辑回归分析，以评估个体因素与胰腺癌之间的相关性。我们进一步评估了特征之间的相互作用，并根据特定的时间窗（诊断前 2-3 个月、4-12 个月、13-36 个月）进行了敏感性分析。
我们共纳入了 141 例病例（37.9%为 I-II 期，2.1%为 III 期，31.4%为 IV 期，28.6%为未知）和 292 例匹配对照。在 24 例（17%）的术前 MRI 扫描中发现了实性肿块。与对照组相比，癌症病例的术前图像更常出现以下胰管表现：主胰管扩张（51.4% vs 14.3%，比值比 [95%CI]：7.75 [4.19-15.44]）、局限性胰管狭窄伴远端（上游）扩张（43.6% vs 5.6%，比值比 12.71 [6.02-30.89]）、不规则（42.1% vs 6.0%，比值比 9.73 [4.91-21.43]）、局限性胰侧支扩张（13.6% vs 1.6%，比值比 11.57 [3.38-61.32]）以及实质表现：萎缩（57.9% vs 27.4%，比值比 46.4 [2.71-8.28]）、局限性信号异常区（39.3% vs 4.8%，比值比 15.69 [6.72-44.78]），均 <0.001。
除了潜在的漏诊病变外，我们还在 MRI 上发现了一系列与胰腺癌发生风险增加相关的胰管和实质特征。
