Pilot study of rapid MR pancreas screening for patients with BRCA mutation
To develop and optimize a rapid magnetic resonance imaging (MRI) screening protocol for pancreatic cancer to be performed in conjunction with breast MRI screening in breast cancer susceptibility gene (BRCA)–positive individuals.
An IRB-approved prospective study was conducted. The rapid screening pancreatic MR protocol was designed to be less than 10 min to be performed after a standard breast MRI protocol. Protocol consisted of coronal NT T2 SSFSE, axial NT T2 SSFSE and axial NT rFOV FOCUS DWI, and axial T1. Images were acquired with the patient in the same prone position of breast MRI using the built-in body coil. Image quality was qualitatively assessed by two radiologists with 12 and 13 years of MRI experience, respectively. The imaging protocol was modified until an endpoint of five consecutive patients with high-quality diagnostic images were achieved. Signal-to-noise ratio and contrast-to-noise ratio were assessed.
The rapid pancreas MR protocol was successfully completed in all patients. Diagnostic image quality was achieved for all patients. Excellent image quality was achieved for low b values; however, image quality at higher b values was more variable. In one patient, a pancreatic neuroendocrine tumor was found and the patient was treated surgically. In four patients, small pancreatic cystic lesions were detected. In one subject, a hepatic mass was identified and confirmed as adenoma by liver MRI.
Rapid MR protocol for pancreatic cancer screening is feasible and has the potential to play a role in screening BRCA patients undergoing breast MRI.
• Develop and optimize a rapid magnetic resonance imaging (MRI) screening protocol for pancreatic cancer to be performed in conjunction with breast MRI screening in BRCA mutation positive individuals.
KeywordsEarly detection of cancer Pancreatic neoplasm Breast cancer Magnetic resonance imaging Screening
Apparent diffusion coefficient
Analysis of variance
Breast-related cancer antigens
Fine needle biopsy
- FOCUS DWI
Field-of-view optimized and constrained undistorted single-shot diffusion-weighted imaging
Fast spoiled gradient echo
Intra-class correlation coefficient
Intraductal papillary mucinous neoplasms
Magnetic resonance cholangiopancreatography
Magnetic resonance imaging
Number of excitations
Pancreatic ductal adenocarcinoma
Pancreatic neuroendocrine tumor
Single-shot fast spin echo
The authors would like to thank Laura Tang, Department of Pathology, Memorial Sloan Kettering Cancer Center, for her assistance in the histopathological analysis.
- This work was supported by the National Institutes of Health (Grant P30 CA008748).
- Supported in part by a grant from the Lustgarten Foundation for Pancreas Cancer Research (DK).
- Work from Giuseppe Corrias was partially supported by a scholarship awarded by ISSNAF Imaging Science Chapter.
The funding sources had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Compliance with ethical standards
The scientific guarantor of this publication is Lorenzo Mannelli.
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Maggie Fung, PhD works for GE Healthcare, Global MR Applications and Workflow, New York, NY, United States.
Statistics and biometry
Marinela Capanu, PhD, and Junting Zheng, MS, kindly provided statistical advice for this manuscript.
Marinela Capanu, PhD, and Junting Zheng, MS, are of the authors and have significant statistical expertise.
Only if the study is on human subjects:
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
- 4.Golan T, Oh D-Y, Reni M et al (2016) POLO: a randomized phase III trial of olaparib maintenance monotherapy in patients (pts) with metastatic pancreatic cancer (mPC) who have a germline BRCA1/2 mutation (g BRCA m). J Clin Oncol 4:15 TPS4152–TPS4152Google Scholar
- 7.Gradishar WJ, Anderson BO, Blair SL et al (2014) National comprehensive cancer network breast cancer panel. J Natl Compr Canc Netw 3:542–590Google Scholar
- 11.Poplin E, Feng Y, Berlin J et al (2009) Phase III, randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 27:3778–3785CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Bamrungchart S, Tantaway EM, Midia EC et al (2013) Free breathing three-dimensional gradient echo-sequence with radial data sampling (radial 3D-GRE) examination of the pancreas: comparison with standard 3D-GRE volumetric interpolated breathhold examination (VIBE). J Magn Reson Imaging 38:1572–1577CrossRefPubMedGoogle Scholar
- 26.Ma C, Li YJ, Pan CS et al (2014) High resolution diffusion weighted magnetic resonance imaging of the pancreas using reduced field of view single-shot echo-planar imaging at 3 T. Magn Reson Imaging 32:125–131Google Scholar
- 31.Shoushtari AN, Covey AM, Zaatari G et al (2014) A woman with metastatic pancreatic neuroendocrine tumor. Gastrointest Cancer Res 7:27–32Google Scholar