title: Contrast-enhanced CT and diffusion-weighted MR imaging: performance as a prognostic factor in patients with pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  To determine whether contrast enhancement of CT and apparent diffusion coefficient on diffusion-weighted MR imaging are important parameters that can predict outcomes for patients with pancreatic ductal adenocarcinoma.
  
  
  METHODS
  Ninety-two patients with histologically confirmed pancreatic ductal adenocarcinoma who underwent quadriphasic CT (including unenhanced, pancreatic parenchymal, portal venous and delayed phases) and fat-suppressed single-shot echo-planar diffusion-weighted MR imaging at 3.0 T were retrospectively analyzed to investigate prognostic factors. Overall survival curves were drawn using the Kaplan-Meier method. Effects on survival of variables including age, sex, tumor location, tumor size, TNM stage, carbohydrate antigen 19-9, carcinoembryonic antigen, treatment, tumor contrast enhancement and apparent diffusion coefficient values were analyzed in univariate analysis using the log-rank test. Variables were analyzed in multivariate analyses using the Cox proportional hazards regression model.
  
  
  RESULTS
  Median survival for the entire patient population was 18.2 months. Higher contrast enhancement during all phases was associated with significantly longer overall survival (P<0.001 for all phases). The difference in overall survival between groups divided by median apparent diffusion coefficient value was not significant (P=0.672). TNM stage (P=0.026) and tumor contrast enhancement on CT (P=0.027) were significantly related to survival in multivariate analysis.
  
  
  CONCLUSIONS
  Poor enhancement of pancreatic adenocarcinomas on enhanced CT is associated with reduced patient survival.
authors.affiliation: Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan. Electronic address: fukukura@m.kufm.kagoshima-u.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Fukukura
authors.affiliation: Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takumi
authors.affiliation: Department of Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Michiyo
authors.initials: M
authors.lastname: Higashi
authors.affiliation: Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.affiliation: Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Kiyohisa
authors.initials: K
authors.lastname: Kamimura
authors.affiliation: Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Yoneyama
authors.affiliation: Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tateyama
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: Computed tomography; Diffusion magnetic resonance imaging; Neoplasm; Pancreas; Prognosis