Charbonneau Janyssa, Noël Patricia, Ouellet Jean-François, Ouellet Jean-François Berthin, Deshaies Isabelle, Daigle Carl, Ouellet Étienne, Brind'Amour Alexandre
Division of General surgery, Department of Surgery, CHU de Québec - Université Laval, Quebec, QC, Canada.
Department of Medical Imaging, CHU de Québec - Université Laval, Quebec, QC, Canada.
Ann Surg Oncol. 2025 May 20. doi: 10.1245/s10434-025-17319-4.
Metastatic presentation is frequent in patients with pancreatic adenocarcinoma and is not always detected on conventional imaging. This study aimed to evaluate the added value of preoperative diffusion-weighted MRI (DWI-MRI) in patients with high-risk pancreatic adenocarcinoma for the detection of peritoneal metastases.
This was a prospective single-center pilot study with an aimed sample size of 40 patients. Eligible patients had pancreatic adenocarcinoma, no evidence of distant metastases on preoperative computed tomography (CT) scan, resectable or borderline resectable tumor, and at least one high-risk feature for peritoneal metastases [tumor size ≥ 3 cm and/or carbohydrate antigen 19-9 (CA19-9) ≥ 400 U/mL]. All patients underwent preoperative DWI-MRI.
A total of 40 patients were recruited, and 38 patients were included for analysis. Mean tumor size on CT scan was 37.3 mm. Median CA19-9 level was 495 U/mL. DWI-MRI revealed undetected peritoneal metastasis in 5.3% of cases (n = 2), but undetected liver metastases in 34.2% of cases (n = 13). DWI-MRI's sensitivity was 86.7% for liver metastases and 78.9% for overall abdominal metastases. The number needed to treat was 2.9 for the detection of liver metastases, and 2.5 for overall abdominal metastases. Unnecessary surgical exploration was avoided in 39.5% of the cohort. Ultimately, 18 patients were selected for curative-intent surgery, but metastases were found intraoperatively in four additional patients. At 6 months, three additional patients had developed metastatic disease.
DWI-MRI revealed few undetected peritoneal metastases, but a significant number of occult liver metastases. Our findings suggest that performing preoperative DWI-MRI in patients with pancreatic adenocarcinoma with high-risk features could be beneficial.
胰腺腺癌患者出现转移的情况很常见,传统影像学检查并不总能检测到。本研究旨在评估术前扩散加权磁共振成像(DWI-MRI)在高危胰腺腺癌患者中检测腹膜转移的附加价值。
这是一项前瞻性单中心试点研究,目标样本量为40例患者。符合条件的患者患有胰腺腺癌,术前计算机断层扫描(CT)未发现远处转移证据,肿瘤可切除或接近可切除,且至少有一项腹膜转移的高危特征[肿瘤大小≥3 cm和/或糖类抗原19-9(CA19-9)≥400 U/mL]。所有患者均接受术前DWI-MRI检查。
共招募40例患者,38例纳入分析。CT扫描显示肿瘤平均大小为37.3 mm。CA19-9水平中位数为495 U/mL。DWI-MRI在5.3%的病例(n = 2)中发现了未检测到的腹膜转移,但在34.2%的病例(n = 13)中发现了未检测到的肝转移。DWI-MRI对肝转移的敏感性为86.7%,对全腹转移的敏感性为78.9%。检测肝转移的治疗所需人数为2.9,检测全腹转移的治疗所需人数为2.5。39.5%的队列患者避免了不必要的手术探查。最终,18例患者被选择进行根治性手术,但术中又有4例患者发现转移。6个月时,又有3例患者出现转移性疾病。
DWI-MRI发现的未检测到的腹膜转移较少,但发现了大量隐匿性肝转移。我们的研究结果表明,对具有高危特征的胰腺腺癌患者进行术前DWI-MRI检查可能有益。