title: PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis.
abstract: OBJECTIVE
  To correlate the clinical stage and prognosis of pancreatic or periampullary cancer with the imaging biomarkers on diffusion-weighted imaging, magnetic resonance spectroscopy and glucose metabolic activity derived from integrated PET/MRI.
  
  
  METHODS
  This prospective study was approved by the institutional review board and informed consent was obtained. The study group comprised 60 consecutive patients with pancreatic or periampullary cancer who underwent PET/MRI before treatment. The imaging biomarkers were the minimal apparent diffusion coefficient (ADCmin), choline levels, standardized uptake values, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) of the tumours. The relationships between these biomarkers and clinical TNM stage were evaluated using the Pearson test and the Mann-Whitney U test. The area under the receiver operating characteristic curve (AUROC) was used to evaluate accuracy. The correlation between the imaging biomarker and progression-free survival (PFS) was investigated using the Cox proportional hazards model.
  
  
  RESULTS
  ADCmin was significantly lower in N1 and TNM stage 3+ tumours. Choline levels significantly higher in T4 tumours. TLG was significantly higher in T4, N1 and TNM stage 3+ tumours. MTV was significantly higher in T4, N1, M1, and TNM stage 3+ tumours (all P < 0.05). The MTV/ADCmin ratio exhibited the highest AUROC for predicting T4, N1, M1, and advanced TNM stages tumours, and was an independent predictor of PFS (P = 0.018) after adjustment for age, sex, tumour size and stage.
  
  
  CONCLUSIONS
  The imaging biomarkers from integrated PET/MRI may predict clinical stage and PFS in patients with pancreatic or periampullary cancer.
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
authors.forename: Bang-Bin
authors.initials: BB
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Tien
authors.affiliation: Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Ming-Chu
authors.initials: MC
authors.lastname: Chang
authors.affiliation: Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Mei-Fang
authors.initials: MF
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
authors.forename: Chih-Horng
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
authors.forename: Xin-Jia
authors.initials: XJ
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Ting-Chun
authors.initials: TC
authors.lastname: Kuo
authors.affiliation: Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
authors.forename: I-Lun
authors.initials: IL
authors.lastname: Shih
authors.affiliation: Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.affiliation: Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan. ttfshih@ntu.edu.tw.|Department of Medical Imaging, Taipei City Hospital, Taipei, Taiwan. ttfshih@ntu.edu.tw.
authors.forename: Tiffany Ting-Fang
authors.initials: TT
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D005947:Glucose / Q000378:metabolism; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D049268:Positron-Emission Tomography / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose
keywords: Diffusion-weighted imaging; MR spectroscopy; PET/MR; Pancreatic cancer; Periampullary cancer; Progression-free survival