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Contrast-enhanced CT and diffusion-weighted MR imaging: performance as a prognostic factor in patients with
Yoshihiko Fukukura1, Koji Takumi1, Michiyo Higashi2
1Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544, Japan.
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.
Materials And 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.
