Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer

• Published in: Radiology and oncology Vol. 53; no. 1; pp. 15 - 24
• Main Authors: Granata, Vincenza, Fusco, Roberta, Setola, Sergio Venanzio, Palaia, Raffaele, Albino, Vittorio, Piccirillo, Mauro, Grimm, Robert, Petrillo, Antonella, Izzo, Francesco
• Format: Journal Article
• Language: English
• Published: Poland Sciendo 01.03.2019; De Gruyter Poland
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Area Under Curve; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Diagnostic systems; Diffusion; Diffusion coefficient; diffusion kurtosis imaging; Diffusion Magnetic Resonance Imaging - methods; Diffusion Tensor Imaging - methods; diffusion weighted imaging; electrochemotherapy; Electrochemotherapy - adverse effects; Electroconvulsive therapy; Feasibility Studies; Female; Fluorouracil - administration & dosage; Humans; Irinotecan - administration & dosage; Kurtosis; Leucovorin - administration & dosage; Magnetic resonance imaging; Male; Mathematical analysis; Medical imaging; Organoplatinum Compounds - administration & dosage; Oxaliplatin - administration & dosage; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - pathology; Parameters; Patients; Retrospective Studies; Sensitivity; Sensitivity analysis; Sensitivity and Specificity; Statistical analysis; Statistics, Nonparametric; Thermal Conductivity; Treatment Outcome; Tumors; electrochemotherapy; diffusion kurtosis imaging; magnetic resonance imaging; pancreatic cancer; diffusion weighted imaging
• ISSN: 1581-3207; 1318-2099; 1581-3207; 0485-893X
• DOI: 10.2478/raon-2019-0004

Background The aim of the study was to evaluate diagnostic performance of functional parameters derived by conventional mono-exponential approach of diffusion weighted imaging (DWI) and by diffusion kurtosis imaging (DKI) in the assessment of pancreatic tumours treated with electrochemotherapy (ECT). Patients and methods Twenty-one consecutive patients with locally advanced pancreatic adenocarcinoma subjected to ECT were enrolled in a clinical approved trial. Among twenty-one enrolled patients, 13/21 (61.9%) patients were subjected to MRI before and after ECT. DWI was performed with a 1.5 T scanner; a free breathing axial single shot echo planar DWI pulse sequence parameters were acquired using seven b value = 0, 50, 100, 150, 400, 800, 1000 s/mm2. Apparent diffusion coefficient by conventional mono-exponential approach and mean of diffusion coefficient (MD) and mean of diffusional kurtosis (MK) by DKI approach were derived from DWI. Receiver operating characteristic (ROC) analysis was performed and sensitivity, specificity, positive and negative predictive value were calculated. Results Among investigated diffusion parameters, only the MD derived by DKI showed a significant variation of values between pre and post treatment (p = 0.02 at Wilcoxon test) and a significant statistically difference for percentage change between responders and not responders (p = 0.01 at Kruskal Wallis test). MD had a good diagnostic performance with a sensitivity of 80%, a specificity of 100% and area under ROC of 0.933. Conclusions MD derived by DKI allows identifying responders and not responders patients subject to ECT treatment. MD had higher diagnostic performance to assess ECT response compared to conventional DWI derived parameters.