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PET/MRI for evaluation of patients with pancreatic cancer

  • Special Section: PET/MR
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Abstract

Pancreatic cancers are the third leading cause of cancer-related death in the USA and outcomes remain poor despite improvements in imaging and treatment paradigms. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently utilized for staging and restaging of these malignancies, but positron emission tomography (PET)/CT can play a role in troubleshooting and improve whole-body staging. PET/MRI is a novel imaging modality that allows for simultaneous acquisition of PET and MRI images, leading to improved image quality and potential increased sensitivity. Early studies suggest that PET/MRI may play a larger role in pancreatic cancer imaging in future. This manuscript will briefly discuss current imaging approaches to pancreatic cancer and outline existing evidence and published data supporting the use of PET/MRI for pancreatic cancers.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. https://doi.org/10.3322/caac.21708.

    Article  PubMed  Google Scholar 

  2. Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol. 2014;20(24):7864-77. https://doi.org/10.3748/wjg.v20.i24.7864.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhang L, Sanagapalli S, Stoita A. Challenges in diagnosis of pancreatic cancer. World J Gastroenterol. 2018;24(19):2047-60. https://doi.org/10.3748/wjg.v24.i19.2047.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kobi M, Veillette G, Narurkar R, Sadowsky D, Paroder V, Shilagani C, et al. Imaging and Management of Pancreatic Cancer. Semin Ultrasound CT MR. 2020;41(2):139-51. https://doi.org/10.1053/j.sult.2019.12.003.

    Article  PubMed  Google Scholar 

  5. Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014;270(1):248-60. https://doi.org/10.1148/radiol.13131184.

    Article  PubMed  Google Scholar 

  6. Chu LC, Goggins MG, Fishman EK. Diagnosis and Detection of Pancreatic Cancer. Cancer J. 2017;23(6):333-42. https://doi.org/10.1097/ppo.0000000000000290.

    Article  PubMed  Google Scholar 

  7. Ergul N, Gundogan C, Tozlu M, Toprak H, Kadıoglu H, Aydin M, et al. Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis and management of pancreatic cancer; comparison with multidetector row computed tomography, magnetic resonance imaging and endoscopic ultrasonography. Rev Esp Med Nucl Imagen Mol. 2014;33(3):159-64. https://doi.org/10.1016/j.remn.2013.08.005.

    Article  CAS  PubMed  Google Scholar 

  8. Kauhanen SP, Komar G, Seppänen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250(6):957-63. https://doi.org/10.1097/SLA.0b013e3181b2fafa.

    Article  PubMed  Google Scholar 

  9. Yeh R, Dercle L, Garg I, Wang ZJ, Hough DM, Goenka AH. The Role of 18F-FDG PET/CT and PET/MRI in Pancreatic Ductal Adenocarcinoma. Abdom Radiol (NY). 2018;43(2):415-34. https://doi.org/10.1007/s00261-017-1374-2.

    Article  PubMed  Google Scholar 

  10. Chen FM, Ni JM, Zhang ZY, Zhang L, Li B, Jiang CJ. Presurgical Evaluation of Pancreatic Cancer: A Comprehensive Imaging Comparison of CT Versus MRI. AJR Am J Roentgenol. 2016;206(3):526-35. https://doi.org/10.2214/ajr.15.15236.

    Article  PubMed  Google Scholar 

  11. Yoon SH, Lee JM, Cho JY, Lee KB, Kim JE, Moon SK, et al. Small (≤ 20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology. 2011;259(2):442-52. https://doi.org/10.1148/radiol.11101133.

    Article  PubMed  Google Scholar 

  12. Kim JH, Park SH, Yu ES, Kim MH, Kim J, Byun JH, et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010;257(1):87-96. https://doi.org/10.1148/radiol.10100015.

    Article  PubMed  Google Scholar 

  13. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB, Jr. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224(3):764-8. https://doi.org/10.1148/radiol.2243011284.

    Article  PubMed  Google Scholar 

  14. Kulkarni NM, Mannelli L, Zins M, Bhosale PR, Arif-Tiwari H, Brook OR, et al. White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY). 2020;45(3):729-42. https://doi.org/10.1007/s00261-019-02290-y.

    Article  PubMed  Google Scholar 

  15. National Comprehensive Cancer Network: Pancreatic Adenocarcinoma (Version 1.2022). https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf Accessed September 8, 2022.

  16. Hope TA, Pampaloni MH, Nakakura E, VanBrocklin H, Slater J, Jivan S, et al. Simultaneous (68)Ga-DOTA-TOC PET/MRI with gadoxetate disodium in patients with neuroendocrine tumor. Abdom Imaging. 2015;40(6):1432-40. https://doi.org/10.1007/s00261-015-0409-9.

    Article  PubMed  Google Scholar 

  17. Mapelli P, Bezzi C, Palumbo D, Canevari C, Ghezzo S, Samanes Gajate AM, et al. (68)Ga-DOTATOC PET/MR imaging and radiomic parameters in predicting histopathological prognostic factors in patients with pancreatic neuroendocrine well-differentiated tumours. Eur J Nucl Med Mol Imaging. 2022;49(7):2352-63. https://doi.org/10.1007/s00259-022-05677-0.

    Article  CAS  PubMed  Google Scholar 

  18. Papadakis GZ, Karantanas AH, Marias K, Millo C. Current status and future prospects of PET-imaging applications in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Eur J Radiol. 2021;143:109932. https://doi.org/10.1016/j.ejrad.2021.109932.

  19. Bozkurt MF, Virgolini I, Balogova S, Beheshti M, Rubello D, Decristoforo C, et al. Guideline for PET/CT imaging of neuroendocrine neoplasms with (68)Ga-DOTA-conjugated somatostatin receptor targeting peptides and (18)F-DOPA. Eur J Nucl Med Mol Imaging. 2017;44(9):1588-601. https://doi.org/10.1007/s00259-017-3728-y.

    Article  CAS  PubMed  Google Scholar 

  20. Mallak N, Hope TA, Guimaraes AR. PET/MR Imaging of the Pancreas. Magn Reson Imaging Clin N Am. 2018;26(3):345-62. https://doi.org/10.1016/j.mric.2018.03.003.

    Article  PubMed  Google Scholar 

  21. Panda A, Goenka AH, Hope TA, Veit-Haibach P. PET/Magnetic Resonance Imaging Applications in Abdomen and Pelvis. Magn Reson Imaging Clin N Am. 2020;28(3):369-80. https://doi.org/10.1016/j.mric.2020.03.010.

    Article  PubMed  Google Scholar 

  22. National Comprehensive Cancer Network:: Neuroendocrine and Adrenal Tumors (Version 1.2022). https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf Accessed September 8, 2022.

  23. Edge SB. AJCC cancer staging manual 8th ed. 8th ed. Cancer staging manual. New York: Springer; 2017.

  24. Furtado FS, Ferrone CR, Lee SI, Vangel M, Rosman DA, Weekes C, et al. Impact of PET/MRI in the Treatment of Pancreatic Adenocarcinoma: a Retrospective Cohort Study. Mol Imaging Biol. 2021. https://doi.org/10.1007/s11307-020-01569-7.

    Article  PubMed  Google Scholar 

  25. Galgano S, Viets Z, Fowler K, Gore L, Thomas JV, McNamara M, et al. Practical Considerations for Clinical PET/MR Imaging. PET Clin. 2018;13(1):97-112. https://doi.org/10.1016/j.cpet.2017.09.002.

    Article  PubMed  Google Scholar 

  26. Hope TA, Kassam Z, Loening A, McNamara MM, Paspulati R. The use of PET/MRI for imaging rectal cancer. Abdom Radiol (NY). 2019;44(11):3559-68. https://doi.org/10.1007/s00261-019-02089-x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jeong WK, Kim YK, Song KD, Choi D, Lim HK. The MR imaging diagnosis of liver diseases using gadoxetic acid: emphasis on hepatobiliary phase. Clin Mol Hepatol. 2013;19(4):360-6. https://doi.org/10.3350/cmh.2013.19.4.360.

    Article  PubMed  PubMed Central  Google Scholar 

  28. ACR Manual on Contrast Media 2022. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf Accessed September 8, 2022.

  29. Calderwood AH, Sawhney MS, Thosani NC, Rebbeck TR, Wani S, Canto MI, et al. American Society for Gastrointestinal Endoscopy guideline on screening for pancreatic cancer in individuals with genetic susceptibility: methodology and review of evidence. Gastrointest Endosc. 2022;95(5):827-54.e3. https://doi.org/10.1016/j.gie.2021.12.002.

    Article  PubMed  Google Scholar 

  30. Huang C, Simeone DM, Luk L, Hecht EM, Khatri G, Kambadakone A, et al. Standardization of MRI Screening and Reporting in Individuals With Elevated Risk of Pancreatic Ductal Adenocarcinoma: Consensus Statement of the PRECEDE Consortium. AJR Am J Roentgenol. 2022;219(6):903-14. https://doi.org/10.2214/ajr.22.27859.

    Article  PubMed  Google Scholar 

  31. Yeh R, Dercle L, Garg I, Wang ZJ, Hough DM, Goenka AH. The Role of 18F-FDG PET/CT and PET/MRI in Pancreatic Ductal Adenocarcinoma. Abdominal Radiology. 2018;43(2):415-34. https://doi.org/10.1007/s00261-017-1374-2.

    Article  PubMed  Google Scholar 

  32. Zhang H, An J, Wu P, Zhang C, Zhao Y, Tan D, et al. The Application of [(68)Ga]-Labeled FAPI-04 PET/CT for Targeting and Early Detection of Pancreatic Carcinoma in Patient-Derived Orthotopic Xenograft Models. Contrast Media Mol Imaging. 2022;2022:6596702. https://doi.org/10.1155/2022/6596702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Zhang Z, Zhou N, Guo X, Li N, Zhu H, Yang Z. Pretherapeutic Assessment of Pancreatic Cancer: Comparison of FDG PET/CT Plus Delayed PET/MR and Contrast-Enhanced CT/MR. Front Oncol 2021;11:790462. https://doi.org/10.3389/fonc.2021.790462.

  34. Joo I, Lee JM, Lee DH, Lee ES, Paeng JC, Lee SJ, et al. Preoperative Assessment of Pancreatic Cancer with FDG PET/MR Imaging versus FDG PET/CT Plus Contrast-enhanced Multidetector CT: A Prospective Preliminary Study. Radiology. 2017;282(1):149-59. https://doi.org/10.1148/radiol.2016152798.

    Article  PubMed  Google Scholar 

  35. Cohen D, Kesler M, Muchnik Kurash M, Even-Sapir E, Levine C. A lesson in humility: the added values of PET-MRI over PET-CT in detecting malignant hepatic lesions. Eur J Nucl Med Mol Imaging. 2023. https://doi.org/10.1007/s00259-022-06099-8.

    Article  PubMed  Google Scholar 

  36. Virarkar MK, Montanarella M, Itani M, Calimano-Ramirez L, Gopireddy D, Bhosale P. PET/MRI imaging in neuroendocrine neoplasm. Abdom Radiol (NY). 2022. https://doi.org/10.1007/s00261-022-03757-1.

    Article  PubMed  Google Scholar 

  37. Evangelista L, Zucchetta P, Moletta L, Serafini S, Cassarino G, Pegoraro N, et al. The role of FDG PET/CT or PET/MRI in assessing response to neoadjuvant therapy for patients with borderline or resectable pancreatic cancer: a systematic literature review. Ann Nucl Med. 2021;35(7):767-76. https://doi.org/10.1007/s12149-021-01629-0.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dunet V, Halkic N, Sempoux C, Demartines N, Montemurro M, Prior JO, et al. Prediction of tumour grade and survival outcome using pre-treatment PET- and MRI-derived imaging features in patients with resectable pancreatic ductal adenocarcinoma. Eur Radiol. 2021;31(2):992-1001. https://doi.org/10.1007/s00330-020-07191-z.

    Article  PubMed  Google Scholar 

  39. Chen BB, Tien YW, Chang MC, Cheng MF, Chang YT, Yang SH, et al. Multiparametric PET/MR imaging biomarkers are associated with overall survival in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging. 2018;45(7):1205-17. https://doi.org/10.1007/s00259-018-3960-0.

    Article  CAS  PubMed  Google Scholar 

  40. Panda A, Garg I, Truty MJ, Kline TL, Johnson MP, Ehman EC, et al. Borderline Resectable and Locally Advanced Pancreas Cancer: FDG PET/MRI and CT Tumor Metrics for Assessment of Neoadjuvant Therapy Pathologic Response and Prediction of Survival. AJR Am J Roentgenol. 2020. https://doi.org/10.2214/ajr.20.24567.

    Article  PubMed  Google Scholar 

  41. Wang ZJ, Behr S, Consunji MV, Yeh BM, Ohliger MA, Gao K, et al. Early Response Assessment in Pancreatic Ductal Adenocarcinoma Through Integrated PET/MRI. AJR Am J Roentgenol. 2018;211(5):1010-9. https://doi.org/10.2214/ajr.18.19602.

    Article  PubMed  Google Scholar 

  42. Harder FN, Jungmann F, Kaissis GA, Lohöfer FK, Ziegelmayer S, Havel D, et al. [(18)F]FDG PET/MRI enables early chemotherapy response prediction in pancreatic ductal adenocarcinoma. EJNMMI Res. 2021;11(1):70. https://doi.org/10.1186/s13550-021-00808-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    Zoey N. Duncan

  2. Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA

    David Summerlin, Janelle T. West, Desiree E. Morgan & Samuel J. Galgano

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Annie T. Packard

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  1. Zoey N. Duncan
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Correspondence to Samuel J. Galgano.

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Duncan, Z.N., Summerlin, D., West, J.T. et al. PET/MRI for evaluation of patients with pancreatic cancer. Abdom Radiol 48, 3601–3609 (2023). https://doi.org/10.1007/s00261-023-03943-9

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